Payer Contracting

CMS uses star ratings to determine the quality of Medicare Advantage prescription drug plans. The agency may terminate a plan sponsor's contract to administer Medicare benefits if it achieves a rating of less than three stars for three consecutive contract…

Newark, Del.-based ChristianaCare is out of network with Humana's Medicare Advantage plans as of Jan. 1. 

Editor's Note: Under a new multi-year agreement, physicians of Baptist Health Medical Group will be in-network for Humana's Medicare Advantage members and commercial group accounts beginning April 1, 2024. 

CMS is terminating Centene's WellCare Medicare Advantage prescription drug plans in Arizona and North Carolina at the end of 2024 following three consecutive years of star ratings below three stars.

Houston-based Memorial Hermann Health System is no longer in network with Humana's Medicare Advantage plans, effective Jan. 1.

UnitedHealthcare went out of network with Little Rock, Ark.-based Baptist Health's hospitals and providers after the payer and health system were unable to reach a new contract. 

UnitedHealthcare moved six Mount Sinai Health System hospitals out of network Jan. 1 amid a contract dispute between the payer and New York City-based health system, according to news releases from both organizations. 

A Medicare Advantage plan jointly owned by Essence Healthcare and Stanford (Calif.) Health Care exited the California market Jan. 1, spokespeople for the organizations confirmed with Becker's.

Cigna and Raleigh, N.C.-based WakeMed have agreed to a two-year contract. 

UnitedHealthcare and Greenville, S.C.-based Prisma Health went out of network Jan. 1 after the two sides failed to reach a new agreement.