Payer Issues Archives - Page 5 of 177 - Becker's Payer Issues

CMS finalizes Medicaid work rules | The active debate among payer CFOs on rising costs | Blue Shield of Calif. spinoff launches payer platform | CMS suspends enrollment for Md. MA plan | CareSource to exit Ind. ACA

CMS has finalized the Medicaid work rules framework + inside the payer CFO debate on rising costs June 2, 2026 1. CMS finalizes framework for Medicaid work rules: 8 things to know Full story 2. No ‘clear-cut answer’: The active…

Elevance avoids MA sanctions | UnitedHealthcare faces $100M Medicaid fraud lawsuit | Hospitals open new front in MA reform fight | 15 payer C-suite exits | PacificSource to cut more jobs

Elevance won’t see MA sanctions for now and Massachusetts accuses UHC of Medicaid fraud June 1, 2026 1. Massachusetts sues UnitedHealthcare over alleged $100M in fraudulent Medicaid payments Full story 2. Elevance escapes Medicare Advantage sanctions threat for now Full story…

Clover wins star ratings lawsuit | Aetna to launch new virtual mental health services | UnitedHealthcare cuts pediatric prior auths | AmeriHealth Caritas sued over alleged hidden pharma fees | Highmark reports health plan turnaround

Clover is the latest to beat CMS in star ratings litigation + more prior auth cuts at UHC May 29, 2026 1. Clover beats CMS in Medicare Advantage star ratings lawsuit Full story 2. Aetna to launch ‘on demand’ virtual mental health services…

Feds overhaul No Surprises dispute process | BCBSND lays off 45 | Non-network insurer eyes exchange | 4 ways payers are building AI-ready workforces | CVS reverses on Zepbound coverage

A No Surprises overhaul years in the making + how a non-network payer is planning for the exchange May 28, 2026 1. Feds finalize No Surprises dispute portal, payer registry: 5 things to know Full story 2. ‘The people part…

Top commercial plans in '26 | BCBS Texas lawsuit against HaloMD dismissed | Humana opens $83M drug distribution center | Cigna's stop-loss margin recovery to wrap in '27 | Dr. Oz taps new CMS chief of staff

Commercial member satisfaction holds flat and another IDR lawsuit is struck down May 27, 2026 1. The top-ranked commercial health plans for member experience | 2026 Full story 2. Humana opens $83M drug distribution center in Florida Full story 3.…

Centene exec departs | UnitedHealth's PBM taps CFO | AI, ICHRA adoption rise as employer health costs surge | CVS sues Tenn. over PBM law | Aetna AI tool cuts claims processing time by 20%

Also: BCBS Illinois office closures May 26, 2026 1. Centene’s chief strategy officer departs Full story 2. AI, ICHRA gain steam as employers face exploding benefits spending Full story 3. Highmark’s CFO shares how to reduce avoidable utilization & improve…

DOJ to depose Elevance exec | Another Ore. payer exits ACA market | Employer health costs jump 7.9% | 3 systems sue CVS over 340B funds | 6 payer M&A updates

Another Oregon payer exits the ACA market and the DOJ will depose a senior Elevance exec May 22, 2026 1. Justice Department can question former Elevance exec in Medicare Advantage fraud case, judge rules Full story 2. PacificSource to exit…

Providence to sunset health plan | Cigna loses bid to dismiss 401(k) lawsuit | Trump traded payer stocks amid MA rate talks | RFK Jr. ousts preventive task force heads | AMA taps COO from UnitedHealth

Another health system pulls back from insurance + Cigna faces a 401(k) mismanagement lawsuit May 21, 2026 1. ‘An untenable situation’: Providence Health Plan to wind down operations Full story 2. Cigna loses bid to dismiss lawsuit alleging 401(k) mismanagement…

BCBS antitrust settlement payouts roll out | Senate Dems pitch Medicare home care coverage | Senior UnitedHealth exec departs | Insurance industry job cuts grow | MA broker payments top $10B: Study

Senate Dems pitch Medicare home care benefits + a long-awaited BCBS settlement payout begins May 20, 2026 1. The $2.67B BCBS antitrust settlement payout: 6 things to know Full story 2. Senior UnitedHealth exec departs Full story 3. A reviewer…

Humana, Cuban's Cost Plus partner | MA enrollment threat could cost Elevance $935M | UnitedHealthcare execs talk commercial strategy | House bill targets MA prior auth, denials | Conn. fines 5 payers over mental health parity

CMS’ MA enrollment threat could cost Elevance $935M + Cuban inks another payer partnership April 27, 2026 1. Elevance sets aside $935M over Medicare Advantage enrollment threat Full story 2. Humana's CenterWell partners with Mark Cuban on employer pharmacy program…