Dual-eligible special needs plan enrollees are twice as likely to have prior authorization requests denied compared to all other Medicare Advantage members, according to KFF.
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California improperly used $52.7 million in federal Medicaid funds to pay for nonemergency care for Medicaid recipients without legal status, according to an audit from HHS' Office of Inspector General.
Seven payers landed among the top 25 healthcare companies on the Fortune 500 in 2024.
Payers are expecting to issue a total of about $1.1 billion in medical loss ratio rebates across all commercial markets in 2024, according to preliminary estimates published June 5 by KFF.
A federal appeals court ruled that a lower court did not abuse its broad discretion by granting Cigna a request for a preliminary injunction barring a former executive from taking a job at CVS Health while a lawsuit over her…
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Ten providers recently posted job listings seeking leaders in payer contracting and relations.
Blue Cross Blue Shield of Massachusetts is expanding access to LGBTQ-focused services for its members.
The nation's largest health insurers have signaled significant headwinds in recent months across their Medicare Advantage and Medicaid businesses as costs rise and the effect of redeterminations takes hold.
Health plans must do a better job of educating members about their benefits and costs while shifting from focusing on compliance around price transparency to member engagement. While digital tools are increasingly important, providers must continue to offer traditional engagement…
SCAN Health Plan has won its lawsuit against CMS that claimed the agency improperly calculated the payer's 2024 Medicare Advantage star rating.