Providence will shutter most of its insurance business beginning in 2027, largely ending more than 40 years as a regional payer and affecting 440,000 members. The Portland, Ore.-based insurer employs 1,150 people and said it would offer them transitional resources…
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Vermont’s ACA insurers, Blue Cross and Blue Shield of Vermont and MVP Health Care, requested lower premium increases for individual and small group plans in 2027, according to May filings. BCBS Vermont said its average requested increases were the lowest…
President Donald Trump’s portfolio managers traded seven health insurers’ stocks as 2027 Medicare Advantage payment policies were being ironed out. The U.S. Office of Government Ethics released disclosures in May laying out thousands of trades in the first three months…
AI agents in action: How Medical Mutual of Ohio transformed the member and employee experience
Sponsored
In a session sponsored by Hippocratic AI at Becker’s 4th Annual Spring Payer Issues Roundtable, Betsy Williamson, RN, vice president, quality performance and population health at Medical Mutual of Ohio, discussed the organization’s experience with generative AI voice agents. The…
A federal judge has denied The Cigna Group’s motion to dismiss a lawsuit alleging mismanagement of employee retirement benefits, according to a May 19 ruling. One year ago, former Cigna employees filed a proposed class action against the company’s 401(k)…
Seven health insurers landed on Forbes’ ninth annual list of America’s Best Employers for New Grads. The ranking, published May 19, was created in partnership with market research firm Statista. It is based on survey responses from more than 100,000…
Medicare beneficiaries enrolled in Part D plans offered by vertically integrated insurers paid lower monthly premiums but higher out-of-pocket drug costs compared to enrollees in other plans, according to a May 19 analysis from the HHS Office of Inspector General. …
Democratic lawmakers have introduced resolutions in the House and Senate to overturn CMS’ Wasteful and Inappropriate Services Reduction (WISeR) model, an AI-assisted prior authorization initiative under traditional Medicare. The effort follows a May 12 determination from the Government Accountability Office…
MCG Indicia Suite: Powering Utilization Management with AI, Automation, and Evidence-Based Precision
Discover how healthcare organizations are transforming utilization management (UM) with the MCG Indicia suite, which combines evidence-based guidelines with advanced artificial intelligence (AI). In this session, MCG will demonstrate how MCG Indicia, Indicia Focus, and Indicia Synapse work together within and…
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Presenter:
- Stacy Jiles, RN, CCM
Personal Care Services attendants account for roughly three times more fraud convictions than any other provider category — and most home health organizations don’t realize how exposed they are. The reason is structural. State exclusions take an average of 420…
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