CMS will launch a voluntary pilot in 2026 to gather service-level data on prior authorization determinations and appeals in Medicare Advantage, according to a Dec. 16 memo. After the pilot, the agency expects to expand the data-collection efforts to all…
Author: Elizabeth Casolo
Digital identity wallet service ID.me entered into a contract with CMS, with rollouts to improve secured access and user experience coming to Medicare.gov in early 2026. ID.me will act as an identity verification and sign-in option for the website. User…
Throughout the year, Becker’s touched base with a handful of Elevance Health leaders — including multiple C-suite executives, a clinical lead and a research VP — to get a pulse on the company’s priorities. They discussed AI, doulas and the…
CMS tracked the percentage of Medicare beneficiaries using various preventative services in the year leading up to fall 2024. The agency collects this data every two years. For 2024, CMS gathered data on the use of seven preventative services. Compared…
Computerworld’s 32nd report on the top places to work in IT featured five health payers. The Dec. 9 list relied on a survey from Computerworld publisher Foundry and included a breakdown by company size and areas of strength. Of the…
Advertisement
Providers win about 80% of “No Surprises Act” cases that reach arbitration, according to Elevance Health Public Policy Institute research published Dec. 10 in Inquiry: The Journal of Health Care Organization, Provision and Financing. Researchers reviewed Elevance Health’s 2023 dispute…
The National Council of Insurance Legislators adopted the Prior Authorization Reform Model Act sponsored by a Mississippi state senator at the group’s annual meeting. “The model will protect the provider-patient relationship from unnecessary third-party interference, prevent programs from hindering the…
U.S. Democratic Sens. Patty Murray of Washington, Ron Wyden of Oregon and Kirsten Gillibrand of New York introduced a bill that would block the CMS Wasteful and Inappropriate Service Reduction model. The six-year WISeR pilot, set to kick off next…
UnitedHealthcare reached a settlement with a cap of $6.75 million in a class-action lawsuit over coverage of proton beam therapy for cancer patients, according to a Dec. 12 court filing in the Massachusetts U.S. District Court. Proton beam therapy is…
California’s Department of Managed Health Care fined three Centene-owned health plans a total of $1.7 million over concerns about not meeting reporting rate standards for timely access of appointments. The department fined Health Net of California $1.2 million, Human Affairs…