Today's Top 20 Stories
  1. Cigna sued by shareholder following ProPublica report on mass claim denials

    A shareholder is suing the Cigna Group in Delaware's Court of Chancery to obtain more information about the company's claims review process following a ProPublica report that alleges the company denies large batches of members' claims without individual review, Law360 reported Sept. 13.
  2. Health insurance executive moves | 2023

    Payer executive moves reported by Becker's in 2023:
  3. MetroPlusHealth names chief people officer

    MetroPlusHealth has named Mary DiGangi as chief people officer. 

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. Medicaid in the headlines: 10 recent updates

    As Medicaid redeterminations continue, Florida is facing allegations it illegally discriminated against families and children of color in its redetermination process, and Hawaii has paused disenrollments for the remainder of 2023 in the wake of the Maui wildfires. 
  2. States ranked by percentage of privately insured residents in 2022

    North Dakota and Utah had the highest percentage of privately insured individuals in 2022, according to data from the U.S. Census Bureau, published Sept. 14. 
  3. BCBS Michigan CEO to retire

    Blue Cross Blue Shield of Michigan's president and CEO, Daniel Loepp is retiring at the end of 2024 after more than two decades with the company.
  4. Universal Health Services rebrands insurance plan to Prominence Health

    Prominence Health Plan, a subsidiary of King of Prussia, Pa.-based Universal Health Services, is rebranding to Prominence Health. 

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. States ranked by percentage of uninsured residents in 2022

    Texas had the highest percentage of uninsured residents in 2022, while Massachusetts had the lowest, according to new data released by the Census Bureau Sept. 14 as part of its American Community Survey. The national uninsured rate was eight percent.
  2. Blue Shield of California opens Long Beach office

    More than 1,000 Blue Shield of California employees will work at the company's new office space in Long Beach.. 
  3. World's best payers, per Time

    Time and Statista released their list of the 750 "best" companies in the world, which includes seven U.S. health insurers.
  4. Meet the CEO of the BCBS affiliate in every state

    Most of the nation's largest health payers have a single CEO at the helm and operate under one name across many states. In contrast, Blue Cross and Blue Shield payers function as smaller, independent companies, though they are often the largest insurer within their respective state.

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. Aetna, Optum can't escape class-action status in 'dummy code' case

    The 4th U.S. Circuit Court of Appeals said Sept. 13 it won't review a lower court's ruling that certified class-action status in a lawsuit alleging Aetna and OptumHealth Care Solutions conspired to use "dummy code" to make administrative fees appear to be billable medical charges.
  2. Common procedures can double in cost when performed at an HOPD vs. ASC, BCBS data shows

    Common medical procedures can cost more than twice as much when they take place in a hospital outpatient setting compared to a physician office or ambulatory surgery center, according to an analysis published Sept. 14 by the Blue Cross Blue Shield Association.
  3. Advice from one of BCBS' longest-serving CEOs

    Mike Murphy, one of the longest-serving Blue Cross Blue Shield CEOs, says relationships with providers have not worsened over his 16 years at the helm of Anthem BCBS Nevada — they've just grown more complicated. 
  4. CVS Health 'optimistic' its Medicare Advantage star ratings will improve

    CVS Health CEO Karen Lynch said she is "optimistic" Aetna will improve its Medicare Advantage star ratings for 2024. 
  5. Value-based care is saving payers billions: 4 programs to know

    Some payers are reporting big savings with value-based care efforts. 
  6. Payers sue to block executive moves

    There is a small pool of executive candidates who can oversee millions of lives and produce positive financial results for large healthcare organizations, and payers have shown they are willing to take those executives to court when they leave for new opportunities.
  7. Oregon health system terminates contract with UnitedHealthcare

    Corvallis, Ore.-based Samaritan Health Services has terminated its commercial and Medicare Advantage contracts with UnitedHealthcare.
  8. CVS Health unconcerned about changes to Blue Shield of California PBM contract

    Reactions to Blue Shield of California's decision to drop its contract with CVS Caremark to manage pharmacy benefits in favor of a partnership with five companies have been overblown, CVS Health CEO Karen Lynch said. 
  9. Civil rights groups file federal discrimination complaint against Florida over Medicaid redeterminations

    The nation's largest Latino civil rights organization, UnidosUS, along with 12 other state and national organizations, have filed a complaint with the HHS Office of Civil Rights regarding what they say is Florida's "illegal discrimination" under the Civil Rights Act against families and children of color amid the state's Medicaid redetermination process.

Top 40 articles from the past 6 months