Today's Top 20 Stories
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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. -
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. -
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.
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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. -
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. -
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. -
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.
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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. -
AI a boost for BCBS Illinois customer service
To enhance its customer service, Blue Cross Blue Shield of Illinois is looking to artificial intelligence. -
CareSource names North Carolina market president
CareSource has named David Herndon as president of its North Carolina market. -
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.
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UnitedHealth Group names senior vice president of external affairs
UnitedHealth Group has named Ed Kaleta as senior vice president of external affairs. -
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. -
5 prior authorization updates
Here are five updates on prior authorization, Becker's has reported since June 18: -
These 40 insurers received Medicare Advantage star upgrades
Forty organizations received revised star ratings from CMS after the agency recalculated its star ratings for 2024. -
Court blocks Medicare Advantage broker fee caps
A federal judge has paused implementation of CMS regulations capping the amount Medicare Advantage companies can pay brokers that sell their plans. -
OIG to probe whether Medicare Advantage plans deny post-acute care
HHS' Office of Inspector General will audit Medicare Advantage plans' use of prior authorization in post-acute care settings. -
5 more states to provide Medicaid coverage to incarcerated people
CMS has approved requests from five states to provide Medicaid coverage to incarcerated people before they are released. -
Cigna's Express Scripts Tricare contract anti-competitive, lawmakers allege
A group of 24 lawmakers expressed concern Express Scripts could be limiting Tricare beneficiaries' choice of pharmacies. -
Texas fines Cigna $600K for claims disputes issues
Texas has fined Cigna $600,000 for failing to comply with multiple independent claims dispute resolution requirements under state law.
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