Today's Top 20 Stories
  1. Cigna, WakeMed reach agreement

    Cigna and Raleigh, N.C.-based WakeMed have agreed to a two-year contract. 
  2. New CMS prior authorization rule takes effect

    A new CMS rule aiming to streamline Medicare Advantage and Part D prior authorizations took effect Jan. 1.
  3. UnitedHealthcare, Prisma Health split

    UnitedHealthcare and Greenville, S.C.-based Prisma Health went out of network Jan. 1 after the two sides failed to reach a new agreement. 

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  1. New payer price transparency rules take effect in 2024

    New requirements for payers under CMS' Transparency in Coverage rule took effect Jan. 1.
  2. The 2-midnight rule and Medicare Advantage: 6 things to know

    There are major changes afoot for Medicare Advantage plans in 2024 and when they are required to cover inpatient services in hospitals for their members. The changes are likely to present challenges for hospitals and how physicians document inpatient care.
  3. Why a Texas congressman is pushing for a Medicare Advantage gold card

    In July, Reps. Michael Burgess, MD, and Vicente Gonzalez, both of Texas, introduced gold-card legislation that would exempt qualifying providers from prior authorization requirements for Medicare Advantage plans. 
  4. UnitedHealth selling Brazil insurance, hospital business to private investor 

    UnitedHealth Group will sell its health insurance and hospital operations in Brazil to a private investor for an undisclosed amount, the company said in regulatory documents filed Dec. 29.

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  1. Top 10 health insurance stories of 2023

    From the start of Medicaid redeterminations to short-lived megamergers, these are the 10 most read health insurance stories reported by Becker's in 2023:
  2. Health insurance executive moves | 2023

    Payer executive moves reported by Becker's in 2023:
  3. The cities where UnitedHealth Group has the largest Medicare Advantage market share

    UnitedHealthcare has at least 75% of the Medicare Advantage market in three cities, according to the American Medical Association. 
  4. 5 recent payer lawsuits, settlements

    From CareFirst suing Johnson & Johnson over alleged anticompetitive biosimilar tactics to Humana accused of using an AI tool to wrongfully deny Medicare Advantage claims, here five lawsuits, settlements and legal developments involving payers that Becker's has reported since Dec. 5:  

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. Medicaid in the headlines: 7 recent updates

    HHS urged nine states to do more to keep eligible children enrolled in Medicaid, and more states are considering Medicaid work requirements. 
  2. The 5 biggest payer AI developments in 2023

    Payers are implementing artificial intelligence to detect fraud, speed up prior authorization and assist members' care. 
  3. California expands Medicaid to all eligible undocumented individuals

    Starting Jan. 1, California will become the first state to offer Medicaid coverage to all eligible undocumented individuals, Cal Matters reported Dec. 28.
  4. Humana's 2023 in 10 headlines

    In 2023, Humana announced plans to end its commercial insurance business, named its next CEO and saw a planned merger with Cigna fall through. 
  5. Senators concerned Medicare Advantage plans deny long-term care

    A pair of senators are asking CMS to require Medicare Advantage plans to cover stays in long-term care facilities at the same rate as traditional Medicare. 
  6. Clover taps former Purdue exec as interim CFO

    Clover Health has named Terrence Ronan as interim CFO, effective Jan. 27.
  7. UnitedHealthcare, Mount Sinai near split date

    New York City-based Mount Sinai Health System could go out of network with UnitedHealthcare on Jan. 1 if the two sides are unable to reach a new contract. 
  8. BCBS Arizona taps Maricopa County Sheriff for exec role

    Blue Cross Blue Shield of Arizona has tapped Maricopa County Sheriff Paul Penzone for a vice president role overseeing the payer's community programs and charitable giving, CBS 5 reported Dec. 14.
  9. 9 top execs that have recently left Cigna

    From its top attorneys to the president of its PBM, these are nine executive departures from the Cigna Group over the last year:

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