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California's Medicaid overhaul has mixed reception so far
California's Medicaid program overhaul is improving access to social services, but many health plans, nonprofit community organizations and other stakeholders say reimbursement rates are not covering the full cost of services. -
The 6 biggest payers with PBMs: Here's a rundown
Here's how the six largest health insurance companies and their pharmacy benefit manager companies stack up. -
States ramp up scrutiny of payers' AI use
States are ramping up scrutiny over how insurers across industries are deploying artificial intelligence for underwriting purposes, Bloomberg reported Nov. 30. -
10 payers audited for Medicare Advantage overpayments in 2023
OIG audits found over $213 million in estimated Medicare Advantage overpayments in 2023. -
8 Effective strategies to decrease denied claims
Approximately 65% of denied claims are not reprocessed for resubmission (Zindl, 2021). Amongst the many challenges facing the healthcare industry, denied claims only continue to rise. Many denied claims are never resubmitted. What does that mean for providers, and what does this mean for the patient experience? -
Texas liquidates Bright Health
Texas has placed Bright Health's subsidiary in the state into receivership and ordered its assets liquidated, according to a court order issued Nov. 29. -
Man sentenced to prison for $30M scheme that defrauded major payers
A Tulsa, Okla., man was sentenced to 54 months in prison for a scheme that involved submitting more than $30 million in claims to major payers for COVID-19 testing services that were never performed. -
Anthem BCBS Virginia, Aledade ink partnership
Anthem Blue Cross and Blue Shield in Virginia has partnered with value-based physician platform Aledade to expand access to primary care for more than 150,000 Medicaid beneficiaries across Virginia. -
Medicare Advantage in the headlines: 8 recent updates
Cigna's Medicare Advantage business may have a potential buyer, and Washington is ramping up scrutiny on prior authorization and transparency in the program. -
Medicare Advantage changes 'incredibly positive,' UnitedHealth CEO says
Medicare Advantage rate changes will have a ripple effect through UnitedHealth Group's business in 2024, but its leaders have a sunny outlook despite lower projected growth. -
OIG: Centene subsidiary received estimated $5.1M in Medicare Advantage overpayments
SelectCare of Texas, a Centene subsidiary, received an estimated $5.1 million in net Medicare Advantage overpayments in 2015 and 2016, according to an audit from HHS' Office of Inspector General published Nov. 27. -
Centene to offer ICHRAs to Indiana employers
Centene's Ambetter Health is partnering with health benefits platform Take Command to offer individual coverage health reimbursement arrangements to employers in Indiana starting next year. -
Medicaid expansion begins in North Carolina
North Carolina's Medicaid expansion program began Dec. 1. -
OIG: 14 states paid managed care organizations $249M for deceased Medicaid enrollees
Fourteen states gave managed care organizations payments for Medicaid enrollees for months after beneficiaries had died, a series of HHS Office of Inspector General audits found. -
5 employer insurance trends to watch in 2024
Employers will be expecting insurers and vendors to deliver more transparency and ways to cut healthcare spending in 2024, according to the Business Group on Health. -
Optum's full-risk Medicare Advantage patients have better health outcomes than Medicare enrollees
Optum patients who are enrolled in fully accountable Medicare Advantage plans — where Optum takes full financial and clinical responsibility — have better health outcomes than patients enrolled in traditional Medicare, according to UnitedHealthcare CEO Brian Thompson. -
Why BCBS Arizona wants to look more like Kaiser
Blue Cross Blue Shield of Arizona is looking to the payer-provider example set by Kaiser Permanente as the Phoenix-based company expands its primary care subsidiary Prosano Health Solutions, the Phoenix Business Journal reported Nov. 20. -
UnitedHealth's 5 growth priorities
UnitedHealth Group outlined its five strategic growth priorities at its annual investor conference Nov. 29: -
UnitedHealth Group projects $400B in 2024 revenue
UnitedHealth Group expects 2024 revenues to be at least $400 billion. -
20% of ACA marketplace enrollees are new to program: HHS
About 4.6 million people have signed up for health insurance through ACA marketplaces as of Nov. 18.
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