Today's Top 20 Stories
  1. Trial underway in Florida Medicaid redeterminations challenge

    A trial is underway to determine if Florida failed to properly notify Medicaid beneficiaries it disenrolled during the unwinding process, the Miami Herald reported July 11.  
  2. CMS cites Aetna in 1st No Surprises Act audit

    Aetna failed to accurately calculate qualified payment amounts for air ambulance services, CMS' first audit of an insurer's No Surprises Act compliance found. 
  3. AI higher investment priority for payer CFOs

    Investing in digital and artificial intelligence technologies is a higher priority for payer CFOs than for their health system counterparts, according to a July 10 report from Deloitte.

The state of AI in healthcare

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  1. Highmark loses 26,000-member contract

    The largest health insurance purchaser in Western New York will award its employee health plan to Univera Healthcare, Buffalo News reported July 11. 
  2. Medicare Advantage in the headlines: 10 recent updates

    CMS published updated star ratings for dozens of Medicare Advantage plans, and a federal judge paused a new CMS regulation that would cap the amount insurers can pay brokers who sell their plans. 
  3. Illinois gov. signs prior authorization reform bill

    Illinois Gov. JB Pritzker has signed a pair of health insurance reform bills into law.
  4. BCBS Louisiana switches to Epic

    Blue Cross and Blue Shield of Louisiana has moved its care management processes and several provider services to the Epic Payer Platform. 

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  1. Payers confronted by COVID vaccine lawsuits

    One Blue Cross Blue Shield plan has lost in federal court for terminating an employee that refused to get vaccinated against COVID-19, and other insurers are facing similar lawsuits.
  2. The 'old-fashioned' weight loss method being embraced by insurers

    As insurers continue to face major financial pressures related to covering weight loss drugs, many are steering more patients toward bariatric surgery to achieve similar results.
  3. Health insurance executive moves | 2024

    Payer executive moves reported by Becker's in 2024:
  4. Florida system's primary care physicians splitting with BCBS Medicare Advantage 

    Fort Myers, Fla.-based Lee Health's Physician Group primary care providers will be out of network with Florida Blue's Medicare Advantage plans by September.

How one Midwest hospital is driving financial efficiency with interconnected systems

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Major time savers can stem from single logins. That's how 1 hospital achieved a 50% reduction in month-end close time — read the short case study, here.
  1. SCAN Group names 5 new execs

    SCAN Group has appointed five new executives, including a chief technology officer and chief marketing officer, to grow its Medicare Advantage business. 
  2. UnitedHealth Group, officials sued over Justice Department probe

    UnitedHealth Group and several of the company's leaders are facing a shareholder derivative lawsuit alleging they failed to disclose that the Justice Department opened an antitrust investigation into the company.
  3. Kansas rejects Aetna's Medicaid challenge

    The Kansas Department of Administration rejected challenges to the state's Medicaid contract procurement process from Aetna and CareSource, the Kansas Reflector reported July 8. 
  4. The 'critical success factor' behind BCBS Michigan's Medicare Advantage program

    Medicare Advantage organizations are facing major challenges, including rising utilization rates, reduced reimbursements, and an evolving regulatory landscape.
  5. AI a boost for BCBS Illinois customer service

    To enhance its customer service,  Blue Cross Blue Shield of Illinois is looking to artificial intelligence. 
  6. CareSource names North Carolina market president

    CareSource has named David Herndon as president of its North Carolina market. 
  7. Highmark names 2 market leaders

    Highmark has promoted Michael Edbauer, DO, to senior vice president of markets and named Jessica Cox as market president for Highmark Western and Northeastern New York.
  8. UnitedHealth Group names senior vice president of external affairs

    UnitedHealth Group has named Ed Kaleta as senior vice president of external affairs. 
  9. Insurers brought in $50B through 'questionable' Medicare Advantage coding: WSJ

    Medicare Advantage plans received $50 billion in payments between 2018 and 2021 for "questionable diagnoses" insurers added to medical records, a Wall Street Journal investigation published July 8 has found. 

Top 40 articles from the past 6 months