Payer

Jefferson Health Plans will enter Pennsylvania's ACA exchange market in 2024. 

Aetna will offer a home health visit from Signify Health to Medicare Advantage beneficiaries at no extra cost as part of the payer's coverage changes for 2024.

Blue Cross Blue Shield of Michigan and Meijer will offer a co-branded Medicare Advantage plan in 2024. 

The Cigna Group will pay $172.3 million to resolve allegations that it violated the False Claims Act by submitting incorrect Medicare Advantage patient data to CMS to receive higher payments from the agency.

The Massachusetts Laborers' Health and Welfare Benefit Fund is suing Blue Cross Blue Shield of Massachusetts again for allegedly overcharging for healthcare and administrative services as the fund's third-party administrator. 

Lawmakers are launching an investigation into the largest Medicaid managed care organizations over prior authorization denial rates. 

The shift from Medicaid coverage to individual exchange coverage is not going as planned, The Washington Post reported Sept. 28. 

Elevance Health has paused a major acquisition and alleged one of its former executives could expose trade secrets to rival Molina Healthcare. 

The CMS innovation center tasked with creating innovative payment models cost the government more money than it saved in its first decade, a report from the Congressional Budget Office found. 

UCare has selected Navitus Health Solutions, a pharmacy benefit manager owned by St. Louis-based SSM Health and Costco, to administer pharmacy benefits to its more than 600,000 members across all lines of business, effective Jan. 1.