Clover Health reported a major boost in profitability and overall membership in its first quarter earnings published May 6. The company’s Medicare Advantage membership stands at 103,418, up 30% year-over-year from just under 80,000. MA membership may hit up to…
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The North Carolina House of Representatives has passed a bill aimed at reforming the prior authorization approval process. The bill requires payers to notify physicians within a specific timeframe if the medical necessity of a service is being questioned. It…
Healthcare costs keep rising, and employers are looking for new ways to manage their employees’ care. In a survey published by Imagine360, more than a third of respondents said they had skipped or postponed necessary healthcare because of the cost. …
VSP Vision has named Scott Nehs chief legal officer and general counsel. Mr. Nehs will be responsible for all legal affairs across the company’s lines of business. He previously served as senior vice president, general counsel and corporate secretary at…
UnitedHealth Group has 1,000 uses for AI technology currently in production across its insurance, care delivery and pharmacy businesses, The Wall Street Journal reported May 5. The applications are split between generative AI and more traditional AI and are being…
Blue Cross Blue Shield of North Carolina is seeking sanctions against LifeBrite Community Hospital of Stokes (N.C.) in a longstanding legal dispute that centers around allegations of fraudulent billing practices. The dispute began in 2018 when LifeBrite accused BCBSNC of…
From plans to exit the individual ACA exchange market to naming a new chief medical officer, here are eight updates on Aetna that Becker’s has reported since March 11: 1. The Department of Justice filed a sweeping lawsuit against Humana,…
Arizona has awarded Medicaid long-term care contracts to four managed plans after a yearlong dispute process. UnitedHealthcare, Centene, Banner-University Care Advantage and Mercy Care will manage the Arizona Long Term Care System-Elderly and/or Physically Disabled program, according to a May…
CareSource will pursue affiliation with Lakeland Care, a Fond du Lac, Wis.-based managed care company. Following regulatory approvals, Lakeland will become part of Dayton, Ohio-based CareSource, which serves more than two million Medicaid members across 13 states. Lakeland serves older…
Highmark Blue Cross Blue Shield Delaware President Nicholas Moriello is stepping down, effective May 9, the Delaware Business Times reported. Highmark has named vice president of commercial business, Tom Fitzpatrick, as acting president, and the company is searching for a…