Today's Top 20 Stories
  1. Humana sues HHS over new Medicare Advantage clawback rule

    Humana is challenging a CMS rule that would implement stricter auditing standards on Medicare Advantage plans. 
  2. UnitedHealthcare hits back at Prisma Health lawsuit

    UnitedHealthcare says it did not breach its contract with Greenville, S.C.-based Prisma Health, and said the health system "coordinated a media effort to put pressure" on the insurance giant. 
  3. UnitedHealthcare's prior authorization cuts begin

    The first wave of UnitedHealthcare's prior authorization cuts began Sept. 1.

A new framework for measuring RCM success — Insights from Denver Health

RCM optimization isn't cheap — but what hospitals really can't afford is sticking to the status quo. Discover how this safety-net hospital is advancing digital transformation in RCM here.
  1. Why Blue Shield of California's CEO thinks more payers will leave traditional PBMs behind

    Blue Shield of California CEO Paul Markovich won't be surprised if other payers ditch traditional pharmacy benefit managers for a new model. 
  2. Centene in the headlines: 7 recent updates

    Centene has moved to divest its overseas businesses and lost out on contract decisions in recent weeks. 
  3. GoodRx launches patient insurance tool for providers

    GoodRx has launched a new feature that allows providers to check a patient's insurance benefits when prescribing medications to better understand the final cost.
  4. Centene reportedly selling last UK business

    Centene is planning to sell its Operose clinics in the U.K., its last remaining business in the country, the Financial Times reported Aug. 30. 

5 signs it's time for end-to-end RCM

There are 5 signs that it's time to switch to end-to-end RCM. Learn what they are + solutions here.
  1. The cost of preventing a heart attack with Wegovy? $1M for insurers

    Wegovy, Novo Nordisk's expensive weight loss drug, could reduce the risk of cardiovascular events — but at a steep cost to insurers, Bloomberg reported Aug. 31. 
  2. CMS to states: Fix your broken Medicaid eligibility systems

    CMS is urging states to correct an issue that could result in eligible people being removed from Medicaid. 
  3. Medicaid in the headlines: 10 recent updates

    More than 5 million people have been disenrolled during the Medicaid redeterminations process. In some states, Medicaid recipients have filed legal challenges to the process, and whistleblowers are raising alarms. 
  4. Highmark names CFO of insurance segment

    Highmark Health Plans has named Ja'Ron Bridges senior vice president and CFO, effective Sept. 25.

How one Midwest hospital is driving financial efficiency with interconnected systems

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. Inland Empire Health Plan names chief people officer

    Inland Empire Health Plan has named Supriya Sood as chief people officer. 
  2. Centene partnering with American Legion on Medicare Advantage plans for veterans

    Wellcare, Centene's Medicare Advantage business, is partnering with the American Legion on Medicare Advantage plans designed to complement benefits veterans receive through the VA. 
  3. UnitedHealthcare community plans prior authorization cuts by category

    UnitedHealthcare is cutting 20 percent of its prior authorizations in two waves. The first cuts take effect Sept. 1 and the second phase goes into effect Nov. 1. 
  4. Humana's CenterWell expanding to in-home primary care

    CenterWell, Humana's older-adult focused primary care business, is expanding to in-home primary care. 
  5. Prisma Health files for temporary restraining order against UnitedHealthcare amid contract negotiations

    Greenville, S.C.-based Prisma Health is alleging UnitedHealthcare breached its confidentiality agreement with the system in the midst of contract negotiations. 
  6. Cigna, Valley Children's split

    Cigna is out of network with some of Madera, Calif.-based Valley Children's Healthcare's facilities. 
  7. Elevance Health in the headlines: 9 recent updates

    Elevance Health has faced legal action and hold-ups to proposed acquisitions in August. 
  8. Regence BCBS Oregon names market president

    Regence BlueCross BlueShield of Oregon has named Michael Cole as market president, effective Sept. 8. 
  9. North Carolina Medicaid expansion unlikely in 2023

    North Carolina's Medicaid expansion could be delayed until 2024, North Carolina Health News reported Aug. 29.

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