Today's Top 20 Stories
  1. AHIP hits back at Medicare Advantage coverage denial report

    America's Health Insurance Plans is criticizing an April 27 report from the HHS Office of Inspector General that found Medicare Advantage Organizations sometimes delayed or denied enrollees' access to services even though the request met Medicare coverage rules.
  2. HHS extends risk adjustment for COVID-19 telehealth services

    HHS said April 29 that it is extending telehealth and telephone-only services in its risk-adjustment program for benefit year 2022 due to the ongoing COVID-19 pandemic. 
  3. UVM Health Network, UnitedHealthcare extend deal 10 days, keep negotiating

    The University of Vermont Health Network and UnitedHealthcare have extended their current contract through May 13, VTDigger reported May 2. 

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  1. 2 states turn to little-used ACA provision to boost health insurance access

    Kentucky and Oregon are creating basic health plan programs to make coverage more affordable to low-income residents, Politico reported April 30. 
  2. 14 payer exec moves in April

    From health tech startups tapping former payer execs to a resignation from a board of directors, these are 14 payer executive moves in the month of April:
  3. States ranked by access to prenatal and maternal healthcare

    New England residents have the best access to high-quality prenatal and maternal care, according to a recent study from ValuePenguin.
  4. BCBS Massachusetts names new senior vice president

    Blue Cross Blue Shield of Massachusetts named Jake Biscoglio as senior vice president of commercial products and customer solutions. 

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  1. BCBS Tennessee names new VP, chief information security officer

    BlueCross BlueShield of Tennessee named Rose Lee as vice president and chief information security officer.
  2. Blue Shield of California taps new senior VP

    Blue Shield of California has named Tim Lieb senior vice president of commercial markets. 
  3. Biden administration halts Georgia plan to have private sector handle ACA marketplace 

    Georgia's plan to bypass the federal ACA marketplace and instead have residents shop through private agents has been suspended by the Biden administration. 
  4. Guidewell, Highmark lead $35M investment round in kidney care company

    GuideWell and Highmark Ventures led a $35 million funding round for kidney population health management company Healthmap Solutions.

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  1. Global insurtech funding breaks record in 2021

    Global investment in insurtech companies broke records in nearly every category in 2021, including total funds invested, deals made, international participation, "unicorn" (companies valued at $1 billion or more) creation, number of companies that went public and the largest single deal, according to Gallagher Re's inaugural "Global InsurTech Report" for the first quarter of 2022. 
  2. CMS issues final 2023 Medicare Advantage, Part D prescription drug rules: 10 things to know

    CMS issued its final 2023 Medicare Advantage and Part D rule that aims to expand access to care and improve health equity through lower out-of-pocket prescription drug costs and improved consumer protections, according to an April 29 press release.
  3. 13 states have extended Medicaid postpartum coverage

    CMS on April 1 expanded Medicaid and Children's Health Insurance Program coverage to allow state plans to offer postpartum care for 12 months. 
  4. Medicare is an inadequate benchmark for commercial health plans, AHA says

    Medicare reimbursement rates should not be the standard to which commercial insurance rates are created, according to the American Hospital Association.
  5. 8 recent improper Medicaid spending stories

    From several state audits revealing Medicaid billing errors to an attorney general accusing UnitedHealth of inflating drug costs, here are eight recent stories involving improper Medicaid reimbursements:
  6. ACA-related coverage reaches record-high 35.8 million people, report says

    A record high 35.8 millions Americans have insurance through ACA-related coverage as of early 2022, according to an April 29 report from HHS. 
  7. Philadelphia Blue Cross collaboration targets disparities in cancer screenings, deaths

    Philadelphia-based Independence Blue Cross is partnering with the national nonprofit Colorectal Cancer Alliance for a new screening and prevention program to close the gap in screening rates and deaths among Black Philadelphians since the start of the pandemic.  
  8. Centene in the headlines: 5 recent stories

    From the resignation of a board member to a restructuring of the CEO's office, here are five recent headlines about the St. Louis-based payer:
  9. 19 Tenet hospitals sue Cigna over alleged low reimbursement rates, denied claims

    Tenet Healthcare and 19 of its hospitals are accusing Cigna of reimbursing claims at low rates and wrongfully denying claims for emergency care in a lawsuit.

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