Montana has clawed back more than $23 million in fraudulent claims after PacificSource flagged more than 200 suspicious ACA enrollments tied to as much as $54.7 million in unjustified claims. A state investigation identified a scheme in which out-of-state individuals…
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Patients who take advantage of zero-cost preventive screenings see better health outcomes and reduced spending, according to January research from BCBS Association and Blue Health Intelligence. The groups reviewed claims data of BCBS members with breast or colorectal cancer. The…
Alameda Alliance for Health, a county-organized Medicaid managed care plan serving more than 400,000 members in Alameda County, Calif., is bracing for a potential 40% to 45% reduction in membership over the next three years as federal Medicaid cuts and…
Alliance of Community Health Plans President and CEO Ceci Connolly sees momentum around risk adjustment reform picking up. “We see this administration taking very seriously the concerns over wide gaps in risk adjustment payments — gaps that are far outside…
Specialty drug growth is accelerating, but billing infrastructure has not kept pace. High-cost therapies now represent a growing share of total drug spend and pipeline volume. At the same time, medical benefit claims, prior authorizations, payer policy changes and 340B…
Mar 26, 2026 12:00 PM - 1:00 PM CDT
Presented by:
Presenters:
- David Pope, PharmD, Chief Pharmacy Officer XiFin, Inc.
- Mike Fauver, Vice President, Enterprise Solutions XiFin, Inc.
- Heather Agostinelli, Vice President, Head of Specialty RCM XiFin, Inc.
Mar 26, 2026 12:00 PM - 1:00 PM CDT
Presented by:
Presenters:
- David Pope, PharmD, Chief Pharmacy Officer XiFin, Inc.
- Mike Fauver, Vice President, Enterprise Solutions XiFin, Inc.
- Heather Agostinelli, Vice President, Head of Specialty RCM XiFin, Inc.
From Optum launching a pair of prior authorization tools to UnitedHealthcare projecting it will lose up to 2.8 million members in 2026, here are 10 updates on UnitedHealth Group and its subsidiaries that Becker’s has reported since Jan. 14: 1.…
CVS Health’s approximately 9,000 community pharmacies began accepting TrumpRx discount cards Feb. 6. The cards offer savings on certain medications for eligible patients, as determined by drugmakers, according to a Feb. 6 CVS news release. Patients can present printed discount…
CMS released participation data Feb. 4 for Medicare accountable care organizations in 2026, showing continued growth in enrollment and a record number of beneficiaries served by the Shared Savings Program. Six things to know:
UnitedHealth’s Optum identified $1.7 billion in potential savings if Minnesota would remedy ambiguity in its Medicaid policies, according to a Jan. 31 from the company. As of October, the Minnesota Department of Human Services had contracted with Optum to analyze claims…