Becker's Payer Issues | Payer News

More than one-third of employers with awareness of individual coverage health reimbursement arrangements are actively preparing for or evaluating them, according to a July 28 survey. The Employee Benefit Research Institute and Morgan Health, a JPMorganChase division, conducted the survey,…

CMS says its “Medicaid Fraud War Room” has identified 50 high-risk providers tied to more than $203 million in Medicaid payments in its first 88 days. In a July 28 news release, CMS characterized the payments as “potentially improper,” and…

Centene’s individual coverage health reimbursement arrangement business has grown to around 50,000 members, two and a half times larger than a year ago, executives said on the company’s second-quarter earnings call July 28. “Some of that is driven by the…

Healthcare company Included Health is acquiring Firefly Health, a clinically integrated health plan and primary care company. Firefly currently serves more than 20,000 individuals across the U.S. Firefly previously reported 15% lower total cost of care in 2025 across its…

Kenneth Burdick, a former Centene executive, has left the company’s board of directors, effective July 28. Mr. Burdick was previously Centene’s executive vice president of products and markets, as well as CEO of WellCare Health Plans. He also served as…

A handful of state legislatures have passed laws this year that limit how health insurers use artificial intelligence when making coverage or reimbursement decisions.  Seven state laws enacted this year:

The Alliance of Community Health Plans is requesting that CMS continue its hold harmless methodology for 2027 Medicare Advantage star ratings, according to a July 27 letter. The trade group of nonprofit health plans called on CMS to calculate each…