Behavioral health providers face immense pressure to verify benefits quickly and correctly — often within an hour of intake. But with payer-specific requirements, Medicaid redeterminations and program variations by state, even one missed detail can delay care or derail reimbursement.…
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Eight percent of Americans were not covered by any kind of health insurance in 2024, remaining at a historic low, according to a September report from the U.S. Census Bureau. Here are six more things to know:
Eight health insurers were featured on Fortune magazine and Great Place to Work Institute’s annual “Best Workplaces in Health Care” list. Fifty large healthcare employers were recognized in total. The rankings were created from employee surveys, which asked participants to…
Two prior authorization reform bills have passed the California legislature and are headed to Gov. Gavin Newsom’s desk. The California Medical Association, which supported the legislation, said in a Sept. 11 news release the bills “aim to dramatically streamline the…
Sen. Richard Blumenthal is urging Cigna to rescind a new policy he said will create “onerous administrative burdens for physicians, needlessly raises costs for healthcare providers and jeopardizes patient care.” Beginning Oct. 1, Cigna’s new Evaluation and Management Coding Accuracy…
The Arizona Department of Insurance and Financial Institutions has ordered RespondersHealth to cease and desist its insurance business in the state, as the company is unauthorized to sell health insurance. According to the Aug. 22 order, in early 2025, the…
Federal and state regulators are turning up the heat, especially in Medicaid and Medicare Advantage. From heightened audit activity to stricter diagnosis coding rules, payers are under growing pressure to get documentation, chart reviews and claims submission right the first…
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Cereasa Horner
Director of Policy and Payment Integrity, CERIS
Steven Hamilton
Partner, Crowell & Moring LLP
Payal Nanavati
Counsel, Crowell & Moring LLP
As a wave of insurers exit Medicare Advantage plans, Health Care Service Corporation is jumping in, launching plans in 948 counties across 30 states and the District of Columbia, according to a Sept. 10 news release. HCSC’s MA plans will…
Consulting groups and organizations are issuing their predictions for healthcare costs in 2026. And so far, they appear steep. Here is a roundup of what these groups are saying: Multiple surveys said employers are pointing to chronic and high-cost conditions,…
New Hampshire’s insurance commissioner is warning that some seniors in the state will have little to no access to Medicare Advantage in 2026 as insurers exit the market, the New Hampshire Union Leader reported Sept. 10. “From what I am…
