A versatile and strategic executive in the healthcare industry. Proven innovator with unique expertise at the intersection of operations, finance, technology, and clinical management. Experience includes companies ranging from start-ups to industry giants.

Clear strategic vision and sense of urgency. Substantial P&L experience. Talent for completing rapid and comprehensive assessment of complex situations, and leading teams to create and implement effective solutions. Results-driven, customer-focused, financially, and technically savvy. 

Brings a broad and deep subject matter expertise in managed care from a payer and a provider perspective and across all industry segments including Medicare, Medicaid, Commercial and Self-Funded lines. 

CORPORATE LEADERSHIP
◆ EVP of Healthcare Delivery, Capital Blue Cross, Harrisburg, PA 
◆ COO, PreferredOne, Golden Valley, MN (sold to United Healthcare)
◆ COO, UNC Health Alliance, UNC Healthcare, Chapel Hill, NC
◆ President, North American Medical Management, Chicago, IL (sold to Optum)
◆ Founder/CEO Dynamic Grape Companies, Mequon, WI 

BOARD SERVICE / ADVISORY / OPERATING PARTNER
◆ Advisory Board Member, Stellar Health
◆ Advisory Board Member, Guardiant Health
◆ Board Member, HC Systems, Bathroom Appliance Innovation
◆ Board Secretary, Minnesota Spay and Neuter Assistance Program 
◆ Commissioner, Minnesota Combat Sports Commission
◆ Former Board Member, Minnesota Council of Health Plans

WOMEN BUSINESS LEADERS of HEALTHCARE | www.wbl.org
◆ Member of the premier network of women executives across the healthcare industry. Members are able to move their companies forward, advance their careers, and make a true impact on the healthcare industry.

Board of Directors Level Leadership |Industry Innovator | Financial & Operational Turnarounds | Growth & Profitability Driver | Financial, IT & Clinical Integration | Strategic & Operational Development | Business Transformation | Consultative Sales & Marketing | Technology Commercialization | New Business Development | Compensation & Contracting Strategies | Value Based Care | Advisor | Product Design | Population Health | Pharmacy | Analytics | Care Management | Coaching | Mentoring

I’m probably one of the only people in America who could untangle this.

And I know exactly what went wrong.

The harder part?
Getting three separate healthcare organizations to each do their part to fix it.

Here’s the situation 👇

A family member has coverage through a BUCA carrier.
A few weeks ago, she had multiple lab tests done — all preventive services.

• In-network provider
• Sent to a national lab (also in-network)

This week she received an EOB.

👉 4 of 5 labs denied
👉 $600 member responsibility
👉 Correct responsibility: $0

One lab was paid. Four were not.

That didn’t make sense.

So I called the carrier.

To their credit, the rep was helpful and confirmed what I suspected:
• The ICD-10 code used was appropriate for one CPT code
• That same diagnosis code was applied to all five labs
• Result: 4 denials

Next call: the national lab.

Their message is clear:

“Diagnosis codes are the responsibility of the submitting provider.”

Sounds reasonable… except for one thing.

I tracked down the lab’s submission form.

Guess what?

❌ Only one diagnosis code field
❌ No way to pair ICD-10 codes to individual CPT codes

In other words:
It is structurally impossible to submit these labs correctly so they pay as preventive.

Next stop: the university health system billing office.

They told me:

“We don’t do office-based labs. You’ll need to call the PCP office.”

Which won’t help—because the PCP entered the code exactly as instructed, using the only field available.

So here we are.

To fix this:
• The national lab must submit a corrected claim
• The PCP office must document that:
– The diagnosis code was correct for Lab #1
– Different diagnosis codes are required for Labs #2–#5

Three organizations.
One patient.
Zero dollars should be owed.

At this point, a formal appeal may be the only path forward.

I’ll keep you posted.

This isn’t a coverage problem.
It’s a workflow problem.
Who’s fixing it?

Stacy Mays

Architect of Market Innovation | Catalyst for Culture & Value Creation | Senior Executive| Board Member

No alternative text description for this image

taplio

Stacy Mays's Linkedin Analytics

Stacy Mays

Performance ScoreStacy Mays's LinkedIn Performance

Stacy Mays's Best Posts (last 30 days)

Ready to grow your LinkedIn presence?

taplio

.css-6ytdur{background-image:linear-gradient(284deg, rgba(39, 43, 72, 1) 0%, rgba(33, 47, 183, 1) 100%);color:transparent;-webkit-background-clip:text;background-clip:text;}Stacy Mays's Linkedin Analytics

Stacy Mays

Performance Score.css-goub6s{font-size:var(--chakra-fontSizes-md);font-weight:500;color:var(--chakra-colors-gray-600);display:block;margin-top:var(--chakra-space-1);}Stacy Mays's LinkedIn Performance

Stacy Mays's Best Posts .css-1emoo84{font-size:var(--chakra-fontSizes-md);font-weight:400;color:var(--chakra-colors-gray-600);}(last 30 days)

Ready to grow your LinkedIn presence?

Stacy Mays's Linkedin Analytics

Performance ScoreStacy Mays's LinkedIn Performance

Stacy Mays's Best Posts (last 30 days)