Today's Top 20 Stories
  1. 11 top execs that have recently left Elevance Health

    From the CFO of its government business division to the COO of Carelon, these are 11 executive departures from Elevance Health and its subsidiaries over the last year:
  2. Kentucky health system dropping UnitedHealth, Centene Medicare Advantage plans

    Louisville, Ky.-based Baptist Health will be out of network with UnitedHealthcare and Centene's Wellcare Medicare Advantage plans, effective Jan. 1, 2024.
  3. The payer CEOs joining Taylor Swift, Oprah on Forbes' most powerful women list

    Taylor Swift is the fifth-most powerful woman in the world, and CVS Health CEO Karen Lynch is the sixth, according to Forbes' ranking of the world's most powerful women. 

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. Proposed class action lawsuit filed to block BCBS Louisiana, Elevance deal

    A Blue Cross and Blue Shield of Louisiana policyholder filed a proposed class action lawsuit seeking to block the insurer's sale to Elevance Health, reported Dec. 5. 
  2. California's Medicaid overhaul has mixed reception so far

    California's Medicaid program overhaul is improving access to social services, but many health plans, nonprofit community organizations and other stakeholders say reimbursement rates are not covering the full cost of services. 
  3. Adventist, Blue Shield of California cut ties across 17 hospitals

    Roseville, Calif.-based Adventist Health and Blue Shield of California have gone out of network across 17 hospitals.
  4. CMS to crack down on Medicaid redetermination compliance

    CMS has laid out how it will sanction states that do not comply with Medicaid redetermination requirements. 

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. 15 top execs that have recently left UnitedHealth Group

    From regional CEOs to its chief growth officer, these are 15 top executives that have recently departed from UnitedHealth Group and its subsidiaries.
  2. Presidential candidates are setting their sights on the ACA. Are voters?

    The Affordable Care Act is back in the political spotlight, but few voters have the future of the law at the top of their lists of issues to address, according to a KFF poll published Dec. 1. 
  3. The 6 biggest payers with PBMs: Here's a rundown

    Here's how the six largest health insurance companies and their pharmacy benefit manager companies stack up. 
  4. States ramp up scrutiny of payers' AI use

    States are ramping up scrutiny over how insurers across industries are deploying artificial intelligence for underwriting purposes, Bloomberg reported Nov. 30.

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. Providence Health Plan taps UnitedHealthcare VP as chief underwriter

    Providence Health Plan has named Louis Flocco as its new chief of underwriting.
  2. 10 payers audited for Medicare Advantage overpayments in 2023

    OIG audits found over $213 million in estimated Medicare Advantage overpayments in 2023. 
  3. Texas liquidates Bright Health

    Texas has placed Bright Health's subsidiary in the state into receivership and ordered its assets liquidated, according to a court order issued Nov. 29. 
  4. Man sentenced to prison for $30M scheme that defrauded major payers

    A Tulsa, Okla., man was sentenced to 54 months in prison for a scheme that involved submitting more than $30 million in claims to major payers for COVID-19 testing services that were never performed. 
  5. Anthem BCBS Virginia, Aledade ink partnership

    Anthem Blue Cross and Blue Shield in Virginia has partnered with value-based physician platform Aledade to expand access to primary care for more than 150,000 Medicaid beneficiaries across Virginia.
  6. Arizona awards long-term managed care contracts to UnitedHealth, Centene

    Arizona has awarded long-term managed care contracts to Centene and UnitedHealthcare.
  7. Medicare Advantage in the headlines: 8 recent updates

    Cigna's Medicare Advantage business may have a potential buyer, and Washington is ramping up scrutiny on prior authorization and transparency in the program. 
  8. Medicare Advantage changes 'incredibly positive,' UnitedHealth CEO says

    Medicare Advantage rate changes will have a ripple effect through UnitedHealth Group's business in 2024, but its leaders have a sunny outlook despite lower projected growth. 
  9. UnitedHealthcare, Baptist Health near split date

    Little Rock, Ark.-based Baptist Health could go out of network with UnitedHealthcare Medicare Advantage plans if the sides are unable to reach an agreement by Dec. 31, Arkansas Money & Politics reported Nov. 30.

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