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CMS is implementing a final rule that will shorten the open enrollment period on the ACA exchange and create stricter…
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CMS is implementing a final rule that will shorten the open enrollment period on the ACA exchange and create stricter eligibility verifications for enrollees. In a June 20 news release, the agency said the changes will lower individual premiums by…
The Trump administration and insurers appear to have their own changes to reimbursement practices in store, with announcements expected next week — adding to funding changes outlined in Congress’ budget reconciliation bills. The Wall Street Journal reported June 20 that…
Medicare Part A will no longer be able to pay the total cost of Medicare beneficiaries hospital costs by 2033, according to the annual Trustees Report. The date is three years sooner than the trustees predicted in 2024. The annual…
At Becker’s 15th Annual Meeting, leaders from Microsoft and Blue Shield of California shared how AI is one tool to help transform payer operations — not by replacing humans, but by personalizing care, cutting friction and restoring trust. Christine McKinney,…
From exploring the sale of a South American-based subsidiary to suing The Guardian for defamation, here are 10 updates on UnitedHealth Group that Becker’s reported since June 2: 1. A federal judge approved a $69 million agreement to settle a…
Curana Health has named Derek Chao, MD, as president and chief medical officer. Previously, Dr. Chao served as CEO of Optum Health’s western region, where he oversaw operations and care delivery across nine states. He had been with the company…
New York City can implement an Aetna Medicare Advantage plan for its retirees, the state’s highest court ruled June 18. The city has pushed to switch its health benefits for retired city employees to a Medicare Advantage plan since 2021.…
Ten providers recently posted job listings seeking leaders in payer contracting and relations. Note: This is not an exhaustive list. Listings were compiled from job-seeker sites. 1. CentraCare, based in Saint Cloud, Minn., seeks a senior director of payer contracting…
How to Build a Technology-First Strategy for UM Effective utilization management (UM) begins with a strategic approach grounded in technology, data, and continuous improvement. As AI adoption accelerates, payers must align their UM strategies with both regulatory demands and operational…
Uncertainty around potential pharmaceutical tariffs is one factor driving up the cost of marketplace coverage in 2025, according to KFF. Multiple insurers, including UnitedHealthcare plans in New York, Maryland and Oregon, and Independent Health have cited tariffs on pharmaceuticals as…