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California’s Department of Managed Health Care issued a cease-and-desist order Nov. 9 to Medicare Advantage insurer Astiva Health. Under the…
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Eleven U.S. House representatives, all Texas Democrats, are pushing government officials to act on the state’s Medicaid application backlog, according to a Nov. 10 news release. The news release said the Medicaid backlog grew from 1,671 pending applications at the…
The Arkansas Department of Human Services secured a temporary six-month extension of its Medicaid expansion waiver, Arkansas Health and Opportunity for Me, according to a Nov. 5 news release. The waiver was slated to expire at the end of 2026.…
Most health systems still plan around instinct. Atlantic Health System spent nearly a decade replacing it with evidence. For close to nine years, Atlantic Health System has put demand forecasting at the center of strategic planning. In this fireside chat,…
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Optum’s artificial intelligence division is partnering with California Medicaid insurer Alameda Alliance for Health to automate claims adjudication using agentic AI. The partnership will start with claims workflows and expand to other operational areas, Ed Bowen, PhD, senior vice president…
Sen. Tammy Baldwin, D-Wis., announced the Medicare at 50 Act on Nov. 10, aiming to lower the eligibility age. Under the bill, people ages 50-64 could buy into Medicare. The buy-in would be optional, and these beneficiaries would be entitled…
Florida’s insurance commissioner has fined 13 pharmacy benefit managers a combined $12.66 million for violating state law, including insurer-owned PBM units. The penalties stem from market conduct examinations under Florida’s Prescription Drug Reform Act, which took effect in 2023. Regulators…
Most revenue cycle teams are not underperforming because people are not trying. They are underperforming because the work is scattered. Every added vendor creates another handoff. Every handoff creates a place where accountability goes soft and a claim can sit.…
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As ACA open enrollment gets underway, Oregon’s Division of Financial Regulation is warning consumers about health plans that label enrollees “limited partners” or “employees” to avoid state consumer-protection rules, as well as “sharing” plans that are not insurance. In a…
Elevance’s Carelon Behavioral Health will pay $2.35 million in penalties, fees and costs and up to $8 million in restitution under two settlements with New York Attorney General Letitia James’ office. The settlements, announced Nov. 10, resolve investigations into mental…
Individual coverage health reimbursement arrangements, recently rebranded to CHOICE, could boost individual ACA enrollment by up to 7.6% in some states while having little effect in others, according to an October analysis from actuarial consulting firm Wakely. The benefits model…
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