Becker's Payer Issues | Payer News

President Donald Trump used his State of the Union address Feb. 24 to plug TrumpRx, criticize the ACA and call out possible Medicaid fraud. While the president addressed affordability more broadly, immigration, and trade, healthcare took up some of his…

The Alabama Senate has passed legislation that would impose new requirements on insurers that use AI to make prior authorization decisions, including a mandate that any decision to deny a request must be made by a physician or other qualified…

Data Integration Key to Achieving Needed Breakthroughs When peers from other industries ask why data hasn’t driven comparable breakthroughs in healthcare, the answer is usually hiding in plain sight: clinical and administrative data still live in different systems and “speak”…

Anthem Blue Cross of California is holding off on its new evaluation and management claim downcoding policy until March 1, pending California Department of Managed Health Care review, according to a Feb. 23 California Medical Association news release. The organization…

SCAN Health Plan will start a “Brokers as Health Navigators” program across its Arizona, Nevada, New Mexico, Texas and Washington markets, according to a Feb. 23 news release. “Many of the best brokers are already acting as trusted advisors, guiding…

In February, CMS released a final report on its Accountable Health Communities model, which launched in 2017 and ran until 2023. The model focused on addressing “upstream drivers of health,” or social determinants, for Medicaid and original Medicare beneficiaries. These…

One question was at the root of Aetna Better Health of Illinois’ recent partnership with Elektra Health, a virtual menopause care platform: “Where are we seeing healthcare needs popping up that don’t have a solution?” During an episode of the…

Geisinger Health Plan has named Jeremy Gaskill as its new president and executive vice president of insurance operations for the Danville, Pa.-based health system.  Mr. Gaskill previously spent more than two decades at Humana, where he most recently served as…

Oakland, Calif.-based Kaiser Permanente is suing nine liability insurers for breach of contract, alleging they have refused to cover any portion of its $556 million settlement with the federal government resolving False Claims Act allegations tied to Medicare Advantage billing…

Editor’s note: The bill was held without a committee vote on Feb. 23. It is not expected to advance this session. Original article: Arizona providers could face license suspension or revocation for submitting too high of payment offers during No…