Payer Contracting

UnitedHealth Group's pharmacy benefit manager OptumRx is settling with the state of Massachusetts over claims that it failed to follow prescription pricing procedures, attorney general Maura Healey announced Feb. 24. 

While Sutter Health allegedly pressured payers to contract with its entire network, a Blue Shield executive said that payers also feared failure to reach an agreement would cause patients to leave for other insurers, according to a Feb. 22 Law360…

Kansas lawmakers are going back and forth on rebidding the state's $3.9 billion Medicaid contract, which could impact the three payers who currently hold it, according to Sunflower State Radio. 

Independence Blue Cross is bringing Bala Cynwyd, Pa.-based Patina Medical Group into its provider network, the payer announced Feb. 22. 

Drew Snyder, director of the Mississippi Division of Medicaid, described the state legislature's move to ban Centene's Medicaid contract as hazardous, and likely to result in litigation against the state, according to a Feb. 17 Daily Journal report. 

Rochester, Minn.-based Mayo Clinic said its recent decision to clamp down on out-of-network patient appointments is a result of capacity issues, not a reimbursement quarrel, the Post Bulletin reported Feb. 15. 

UnitedHealthcare secured a contract to administer the District Dual Choice program in Washington, D.C.

The Louisiana Department of Health will award five payers contracts to administer its state Medicaid program. 

Rochester, Minn.-based Mayo Clinic is no longer allowing some Medicare Advantage beneficiaries to schedule appointments, according to the Star Tribune. 

Software glitches from Sunshine Health resulted in tens of thousands of disadvantaged children's healthcare claims being delayed for about three months, according to the Tampa Bay Times.