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Federal lawmakers have introduced a handful of bills aimed at speeding up prior authorization and cracking down on upcoding in…
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Federal lawmakers have introduced a handful of bills aimed at speeding up prior authorization and cracking down on upcoding in Medicare Advantage. None of the introduced bills have been heard in committee. Here are five proposals introduced in 2025 to…
In June, more than 50 insurers agreed to a set of voluntary actions aimed at simplifying the prior authorization process. The group of insurers, backed by leaders including CMS Secretary Mehmet Oz, MD, said they will work to implement a…
A new peer-reviewed study analyzed real-world data from patients of a large, risk-bearing provider, who were also covered by one of New Jersey’s largest health plans. It found that a non-invasive, home-based treatment for knee and back pain reduced musculoskeletal…
Amar Desai, MD, is out as CEO of Optum Health, Bloomberg reported June 26. Patrick Conway, MD, CEO of Optum, will also take over as CEO of Optum’s health division, Bloomberg reported, citing an internal memo. Dr. Desai will remain…
An Ohio state judge has temporarily barred a Texas-based insurer that sold health insurance plans to retired law enforcement and fire personnel from operating in the state due to violations of insurance laws. On June 25, a Franklin County judge…
Effective data interoperability in healthcare is no longer an optional enhancement; it’s an essential function for modern medical systems. With its potential to significantly improve operational efficiency and patient outcomes, interoperability ensures seamless communication between diverse healthcare systems. Federal mandates…
Louisiana Gov. Jeff Landry has vetoed a key provision from the state’s budget plan that would have required coverage of weight loss medications for state employees and their dependents for the upcoming fiscal year, citing concerns over long-term costs. The…
Clear answers to questions are the top driver of members’ experience with their insurers, according to a report from Forrester. The research firm scored insurers on the brand experience index, which measures customers’ and noncustomers’ brand perception, and customer experience…
GuideWell, the parent company of Florida Blue and several health services companies, was ranked on the Fortune 500 for the first time. Guidewell, a not-for-profit mutual holding company, was ranked No. 136 on the list. In a June 25 LinkedIn…
Ahead of the health insurance industry’s broader pledge to overhaul prior authorization processes, one Texas payer has already achieved a 7% prior authorization denial rate, with 100% of those denials upheld upon appeal. On June 23, nearly 50 insurers committed…