In recent months, payers across the country have tried tightening policies to get a better grip on evaluation/management coding. While payers often say the policies aim to control costs or combat fraud, these more restrictive policies are often met with…
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Network Health, a Wisconsin-based insurer owned by Froedtert ThedaCare Health, grew 37% during this past annual enrollment period to 126,000 total Medicare Advantage members, its second consecutive year of record growth. The plan also posted a 98% member retention rate.…
Sidecar Health members can now see a guaranteed price for nearly every physician visit in the U.S. before receiving care. The update covers all office visits nationwide, from primary care to specialists and therapists, as well as common add-on services…
Health systems are investing heavily in AI, digital care models and patient experience. But many are building on aging energy infrastructure never designed to support always-on digital operations and expanding clinical demands. Outdated systems do more than increase maintenance costs.…
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Health Alliance Plan promoted Chris Moyer to senior vice president of markets, broadening his role as president of ASR Health Benefits, a subsidiary and third-party administrator for employer health plans. According to a March 4 news release from HAP, which…
Blue Cross Blue Shield of Wyoming President and CEO Diane Gore will retire after 40 years with the organization, the company said March 4. Ms. Gore is the fifth CEO in the company’s 80-year history, first joining BCBSWY in her…
Express Scripts agreed to pay a $1.5 million administrative penalty and implement corrective actions following an investigation by the West Virginia Offices of the Insurance Commissioner. Between May 2024 and August 2025, the state office reviewed the pharmacy benefit manager’s…
Hospital and health system development leaders are navigating a competitive ASC market shaped by rising acquisition activity and regulatory change. This new ASC valuation survey report reflects insights from 21 respondents whose organizations collectively own or manage more than 25%…
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Minnesota filed a lawsuit against CMS and HHS, as well as their respective leaders, Mehmet Oz, MD, and Robert F. Kennedy Jr., regarding $243.8 million in deferred Medicaid funds, according to March 2 documents filed through the U.S. District Court…
Picture a pilot that surpasses its savings goal within 90 days and then scales across a health system. At Ardent Health, an initial target of $32.50 per admission quickly became $97 per admission during the pilot. After expansion, average savings…
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