Payer

While the world of healthcare remains ever changing, Seattle, Wash.-based First Choice Health, a provider and hospital-owned healthcare company, is looking to expand its network footprint in 2024. 

California's managed healthcare department fined Blue Shield of California $200,000 for mishandling provider claims. 

The Federation of American Hospitals is asking CMS to include how often Medicare Advantage carriers uphold or overturn initially denied prior authorization requests into how the agency calculates star ratings for the program. 

Kraft Heinz has voluntarily dismissed a lawsuit against Aetna alleging the payer breached its fiduciary duties and used its role as third-party claims administrator for Kraft's employee health plan "to enrich itself" to the food manufacturer's detriment.

Almost three-quarters of the nation's local Medicare Advantage markets are highly concentrated, according to the American Medical Association. 

Elevance Health's managed Medicaid plans in 21 states have been recognized by the NCQA for their advanced health equity efforts.

Almost half of the nation's local commercial insurance markets are majority controlled by one payer, according to the American Medical Association. 

Two Little Rock, Ark.-based ASCs are seeking potentially millions of dollars in unpaid reimbursements from Arkansas Blue Cross and Blue Shield for procedures performed during the COVID-19 pandemic, Arkansas Business reported Dec. 11.  

Centene CEO Sarah London foresees major disruption opportunities ahead in the employer group insurance market by way of individual marketplace coverage.

Humana used an artificial intelligence tool owned by UnitedHealth Group to wrongfully deny Medicare Advantage members' medical claims, according to a class-action complaint filed Dec. 12.