Today's Top 20 Stories
  1. Medicare Advantage plans dropping meal benefits, in-home support

    Fewer Medicare Advantage plans will offer nonmedical supplemental benefits like home modifications, adult day health services and therapeutic massage in 2024, according to an analysis from ATI Advisory published Oct. 30. 
  2. States ranked by annual Medicaid managed care spend

    New York spends the most on its Medicaid managed care program every year, according to data published by KFF in November. The U.S. total is more than $441 billion.
  3. 'Flagrant disregard of the law': Nebraska revokes Bright Health's insurance license

    Nebraska has fined Bright Health $1 million and revoked its insurance license with the state following a market conduct examination that found the company violated state law more than 21,000 times over a period of two years.

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  1. 7 prior authorization updates

    From UnitedHealthcare starting its second wave of cuts to lawmakers urging CMS to increase its oversight of artificial intelligence used in Medicare Advantage prior authorizations, here are seven updates on prior authorization Becker's has reported since Sept. 18. 
  2. CMS proposes new Medicare Advantage audit appeals process

    CMS is proposing a standard appeals process for risk adjustment data validation audits in Medicare Advantage. 
  3. Why Humana is sponsoring 4 pickleball organizations

    Humana announced it is sponsoring four pickleball organizations in response to the increasingly popular sport's "life-changing benefits both on and off the courts," according to a Nov. 6 news release. 
  4. CMS proposes more crackdowns on Medicare Advantage marketing, broker payments

    CMS is proposing a set of new Medicare Advantage rules, including new standards that would impose more limits on plans' payments to brokers and limit the role of third-party marketers. 

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  1. CMS proposes health equity mandates for Medicare Advantage prior authorizations

    CMS is proposing new health equity changes for prior authorization policies and procedures at Medicare Advantage organizations to better determine any disproportionate impact on underserved populations that may delay or deny access to services. 
  2. Lawmakers probe Medicare Advantage plans' use of AI

    A group of federal lawmakers is asking CMS to increase its oversight of artificial intelligence and algorithms used in Medicare Advantage prior authorization decisions. 
  3. BCBS Illinois fined a third time for network adequacy law violations

    The Illinois Department of Insurance has fined Health Care Service Corp., the parent company of Blue Cross Blue Shield of Illinois, nearly $1.2 million in less than two years for violating the state's Network Adequacy and Transparency Act, which requires payers to publish complete and accurate provider directory information. 
  4. Medicare Advantage doesn't hurt rural hospitals: Study

    Increasing Medicare Advantage enrollment in rural areas did not increase rural hospitals' financial distress or risk of closing, a study published Nov. 3 in the American Journal of Managed Care found. 

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. Cigna reportedly considering selling Medicare Advantage business

    The Cigna Group is exploring a potential sale of its Medicare Advantage business, Reuters exclusively reported Nov. 6. 
  2. BCBS Massachusetts to cut 14,000 prior authorization requirements

    Blue Cross Blue Shield of Massachusetts is removing 14,000 prior authorization requirements for home care services for its 2.6 million commercial members beginning Jan. 1. 
  3. Providence Health Plan taps 3 new finance execs

    Providence Health Plan has added three new executives to its finance team, according to a Nov. 1 news release.
  4. 23 payer executives' top priorities for 2024

    Payer leaders are turning their attention to health equity, prior authorization, AI and more as 2024 approaches. 
  5. Allstate looking to sell health benefits division

    Allstate is looking to sell its health benefits division in 2024, CEO Tom Wilson told investors on a Nov. 2 quarterly earnings call.
  6. NCAA president, former Massachusetts governor joins UnitedHealth Group board

    UnitedHealth Group has named Charlie Baker to its board of directors. 
  7. New York payer laying off 68 employees

    AgeWell, a specialty managed care insurer, is laying off 68 employees at its headquarters in Lake Success, N.Y., according to regulatory documents published by the state Oct. 31.
  8. Payers ranked by total enrollment in Q3

    The nation's largest payers have filed their third-quarter earnings reports, revealing which grew total member enrollment and business lines the most year over year.
  9. Payers ranked by medical loss ratios in Q3

    The nation's largest payers have filed their third-quarter earnings reports, revealing how medical loss ratios changed year over year. Individual BCBS company MLRs for the first half of 2023 are here.

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