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Oregonians have free reproductive healthcare coverage; 12 insurers charged beneficiaries anyway
A law that went into full effect in 2019 granted Oregon residents free reproductive healthcare coverage, but state officials found that at least 12 insurers continued to charge beneficiaries, according to a Feb. 1 report from the Oregon Capital Chronicle. -
Cigna posts $1.2B profit in fourth quarter
Cigna beat investor expectations and reported $1.2 billion in profit for the fourth quarter, according to its year-end earnings report published Feb. 3. -
What providers needs to know about CMS' plan to clawback $4.7B in Medicare Advantage payments
More scrutiny is expected for providers who serve patients covered by Medicare Advantage. -
Payers with most MA prior authorization requests, denials
Elevance Health has the highest number of prior authorization requests per Medicare Advantage member, while CVS and Kaiser Permanente have the highest rate of denials in 2021, according to an analysis from Kaiser Family Foundation. -
Prior authorization and Medicare Advantage: 5 numbers to know
Medicare Advantage plans fully or partially denied around 6 percent of prior authorization claims in 2021, according to an analysis from Kaiser Family Foundation published Feb. 2. -
9 updates on prior authorization
From CMS issuing a proposed rule to streamline the process, to a report indicating a majority of states could introduce bills this year to limit or change the process, here are nine stories about prior authorization Becker's has reported since Nov. 28: -
How Health Net is making sure members know about Medicaid redeterminations
Health Net is launching a "review to renew" campaign to inform its millions of Medicaid members in California about upcoming redeterminations. -
Where government insurance enrollment stands in 2023
CMS released 2023 enrollment figures for government-sponsored health plans Jan. 31. -
UnitedHealthcare overpayment, appeal letters going paperless in 13 states
UnitedHealthcare will stop mailing overpayment and appeal decision letters to primary and ancillary healthcare providers in 13 states and Washington, D.C., starting May 5. -
2,000 BCBS Michigan beneficiaries may have another member's bill
About 2,000 Blue Cross Blue Shield of Michigan beneficiaries may have someone else's January premium bill, NBC affiliate WDIV reported Jan. 31. -
Centene to pay Indiana $66M in latest overbilling settlement
Centene has agreed to pay Indiana more than $66 million to settle allegations it overbilled the state's Medicaid program for pharmaceutical services. -
Humana posts $15M Q4 loss, names top execs
Humana posted revenues of nearly $93 billion in 2022 and a net loss of $15 million in the most recent quarter, according to its year-end earnings report published Feb. 1. -
How BCBS Tennessee will use its 1st ever health equity report
BlueCross BlueShield of Tennessee has completed its first annual health equity report and will use the findings as a benchmark to drive further progress, Andrea Willis, MD, chief medical officer for BCBS Tennessee, said in the Tennessean Jan. 26. -
Medicare Advantage in the headlines: 7 recent updates
Medicare Advantage plans will face tougher auditing standards after a highly-anticipated ruling from CMS. The program also hit 30 million members in recent weeks, and payers are expecting enrollment numbers to keep climbing. -
Lawmakers reintroduce bill to rename Medicare Advantage plans
A trio of U.S. representatives has reintroduced a bill that would rename Medicare Advantage plans, prohibit private insurers from using "Medicare" in plan titles or advertisements and impose "significant fines for any insurer that engages in this deceptive practice." -
Senators probe payer mental healthcare 'ghost networks'
A group of senators is seeking answers from major payers over "ghost networks" that make it difficult for patients to find in-network mental healthcare providers. -
7 reactions to CMS' Medicare Advantage audit ruling
Organizations representing payers say tougher auditing standards CMS will impose on Medicare Advantage plans could create higher premiums and fail to target fraud. Others say the new rule, which eliminates the fee-for-service adjuster, doesn't go far enough. -
CMS announces special ACA enrollment period for those losing Medicaid coverage
CMS is opening an ACA special enrollment period for those losing healthcare coverage after the end of Medicaid's continuous enrollment provision. -
How states are preparing for Medicaid redeterminations
State Medicaid departments had been waiting for more than a year for certainty of when the unwinding of Medicaid's continuous coverage provision would begin, according to Kate McEvoy, executive director of the National Association of Medicaid Directors. -
Senators reintroduce bills to reform PBM industry
A bipartisan group of senators are once again pushing for new regulations around the pharmacy benefit manager industry.
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