Medicare Advantage insurers made almost 53 million prior authorization decisions in 2024, according to a Jan. 28 KFF analysis. KFF relied on insurer data reported to CMS, focusing on service determinations, not claims determinations for services already provided. Withdrawn and…
Author: Elizabeth Casolo
A Kentucky bill introduced Jan. 21 would require the state’s insurers to offer prior authorization exemptions in the state. The bill has bipartisan backing and includes two Republican healthcare professionals — state Reps. Kimberly Moser and Robert Duvall — as…
The House passed a bipartisan healthcare funding package Jan. 22. The most recent version includes a provision addressing Medicare coverage for multi-cancer early detection screenings. The bill is now in the Senate’s hands. If it passes, Medicare beneficiaries would also…
BCBS Arkansas promoted Anne Gardner to chief privacy officer, according to a Jan. 27 news release shared with Becker’s. In the role, which Ms. Gardner stepped into in 2025, she oversees the company’s information privacy program, encompassing HIPAA compliance, impact…
Active-duty family members enrolled in Tricare Prime Remote will no longer face copays when filling covered prescriptions, according to a Jan. 27 news release from the military’s healthcare program. Tricare Prime Remote is a managed care offering for military families…
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Elevance Health posted nearly a $5.7 billion profit in 2025, the insurer revealed in its full-year and fourth-quarter earnings report published Jan. 28. Elevance had cut its earnings guidance in July due to steeper individual market and Medicaid costs. Total…
Forty-eight states, plus the District of Columbia, have been offering continuous Medicaid coverage for one year postpartum — but states do not always set clear expectations for how their managed care organizations can support this population. In 2021, states were…
Bloomington, Minn.-based HealthPartners and Quartz are working together on self-funded health plan options for employees. Large, commercial employers across Minnesota and Wisconsin will have coverage options that offer robust administrative resources, as well as strong regional and national provider networks.…
Richard Whitmer, former president and CEO of BCBS Michigan and father of Michigan Gov. Gretchen Whitmer, died Jan. 26, according to a statement from his daughter. Mr. Whitmer, who was 85 years old, according to his obituary in the Detroit…
Providers, facilities and air ambulances won 88% of disputes in the first half of 2025. In January, CMS released independent dispute resolution data from the first and second quarters of 2025, including details on disputing parties and payment determinations. The…