Payer Issues Archives - Page 19 of 167 - Becker's Payer Issues

How a Texas payer cut prior auth denials to 7% | CVS fined $95M for inflating Medicare drug prices | Insurers lag on customer experience | Optum launches AI marketplace | 10 recent billing fraud cases

June 26, 2025 1. How a Texas payer cut prior auth denials to 7% ahead of industry reform pledge Full story 2. CVS Caremark ordered to pay $95M for inflating Medicare drug prices Full story 3. CMS is cracking down…

MA tied to longer hospitalizations, lower costs | Some UnitedHealth workers return to office | Humana affected by Novo Nordisk, Hims & Hers split | ACA enrollment could shrink by 50% | RFK Jr. leans into wearables

June 25, 2025 1. Medicare Advantage members have longer hospital stays than those with traditional Medicare: NORC study Full story 2. Medicare Advantage, traditional Medicare cost gap widening: Better Medicare Alliance Full story 3. What's really shaping payer strategy in…

Ga. health system bets on new insurance model | Optum subsidiary reports data breach | Medicare faces 2033 cliff | Lawmakers target MA, VA loophole | 20 payers cutting jobs

June 24, 2025 1. Why a Georgia health system is investing in a new insurance model Full story 2. Optum subsidiary reports February data breach Full story 3. Care navigation doesn't have to be chaos. See how payers are leveling…

Payers to ease prior auths | NYC reverses course on Aetna MA plan | CMS finalizes ACA integrity rule, raises MA commission caps | Trump’s approach to PBMs | 12 drugs in shortage

June 23, 2025 1. Payers to reduce prior authorizations Full story 2. CMS finalizes rule to improve ACA marketplace integrity, lower premiums Full story 3. What's next for value-based care? Aetna, Emblem & BCBS are scaling smarter models — learn…

Medicaid top of mind for payer execs | Court greenlights NYC's Aetna MA plan | Optum West CEO departs | MA enrollees see fewer home health visits: MedPAC | 4 GLP-1 updates

June 20, 2025 1. Medicaid top of mind for payer execs: 15 leaders' biggest priorities Full story 2. State high court greenlights New York City's $15B Aetna Medicare Advantage plan Full story 3. The AI agent advantage is real — and…

Tariffs threaten to raise premiums | Judge OKs class-action against BCBS Mont. | MA architect: The system is being abused | More payers seek higher ACA rates | Walmart launches MA, Medicaid wellness program

June 19, 2025 1. Tariff threats contribute to rising premiums: 3 things to know Full story 2. Why an architect of Medicare Advantage says the 'system is being abused' Full story 3. $57.7B lost to avoidable readmits. How LTACHs are cutting risk…

Former MA exec acquitted | Payers face 'deteriorating' outlook: Fitch | Lawmakers pitch Medicare public option | ICHRA growth surges | Judge approves UnitedHealth 401(k) settlement

June 18, 2025 1. Former Medicare Advantage exec acquitted on fraud charges Full story 2. GOP budget bill leaves payers with 'deteriorating' outlook: Fitch Full story 3. BCBS, Cigna & Humana are rethinking cost, access and experience. Their game plan —…

UnitedHealth cuts some MA commissions | Senate GOP floats steeper Medicaid cuts | Ochsner Health Plan CEO heads to Aetna | Viewpoint: MA execs should enroll in their plans | Humana CEO details 5-year plan

June 17, 2025 1. UnitedHealth cuts some Medicare Advantage broker commissions Full story 2. Humana's path forward as a consumer healthcare company: 5 things to know Full story 3. A 4-step roadmap to modernizing prior auth — get the guide…

CMS shares Medicaid data with immigration officials | UNC sues Aetna, Humana over 340B payments | Mercy, Humana open joint clinics | How Congress gets health coverage | 'Payer scorecards' pay dividends to hospitals

June 16, 2025 1. CMS ordered to provide Medicaid data to immigration officials: Report Full story 2. UNC Health sues Aetna, Humana for alleged 340B drug underpayments Full story 3. Medicare Advantage, AI: What's really shaping payer strategy in 2025?…

Humana's CMO details ambient AI pilot | Former UnitedHealth employees drop WARN violation claims | 6 payers recently fined | The Trump admin's approach to MA | Cigna adds new AI tools

June 13, 2025 1. Humana's top physician details ambient AI pilot: 5 notes Full story 2. Former UnitedHealth employees drop claims alleging WARN Act violations Full story 3. New chronic wound research could shift coverage policies. What payers should know…