CMS Administrator Mehmet Oz, MD, told FOX 5 Atlanta that the government shutdown is not affecting Medicare open enrollment. “The shutdown is a problem for lots of parts of government but not for [Medicare] open enrollment,” he said. “Medicare is…
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CMS mandates for interoperability, patient access and prior authorization — CMS-9115-F and CMS-0057-F — are fundamentally changing how payers and providers must share data, with enforcement deadlines extending into 2026. The good news: Compliance doesn’t necessarily require ripping and replacing…
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Presenters:
- Joerg Schwarz, Senior Director for Healthcare Interoperability Solutions and Strategy, Infor
- Chris Smith, MS, Enterprise Architect, Mississippi Division of Medicaid
The high cost of GLP-1 drugs have thrown a curveball at payer strategy. Employers providing health insurance are also grappling with the fallout. From January to July, Davis Research interviewed business owners and human resource and benefits managers at 1,862…
Los Angeles-based Cedars-Sinai and Anthem Blue Cross of California are extending their contract until Jan. 1, 2030, the health system said in a news release shared with Becker’s. More than 230,000 Anthem members will stay in network under the multiyear…
While best known for our healthcare technology, InterSystems is a global leader in interoperability across multiple industries. One goal common to all of them is achieving the level data liquidity needed to unlock simultaneous breakthroughs in quality and efficiency. However,…
In 2025, the average annual premium for family health insurance reached $26,993, according to KFF’s employer health benefits survey. From January to July, Davis Research interviewed business owners and human resource and benefits managers at 1,862 firms for the survey.…
Capital District Physicians’ Health Plan has named Barry Thornton II as its next CEO, effective Jan. 1. He succeeds Brian O’Grady, who is retiring after more than a decade at the company. Mr. Thornton currently serves as COO at the…
SCAN Health Plan and Costco Wholesale Corp., a preferred pharmacy for the insurer, are collaborating to offer older adults a rewards program, provide them with greater flexibility with spending benefits and educate them about Medicare. Senthu Arumugam, SCAN’s chief commercial…
Johnson City, Tenn.-based Ballad Health is suing UnitedHealth Group for alleged “Medicare Advantage manipulation” that has led to denied care and underpayment for services. The lawsuit was filed Oct. 21 in a Tennessee federal court and claims that UnitedHealth’s actions…
Elevance Health is working to mitigate rising costs in its Medicaid business amid what executives describe as a challenging year ahead. The company reported its third-quarter earnings on Oct. 21, with senior leadership telling investors that escalating Medicaid costs, driven…