CMS will launch a voluntary pilot in 2026 to gather service-level data on prior authorization determinations and appeals in Medicare Advantage, according to a Dec. 16 memo. After the pilot, the agency expects to expand the data-collection efforts to all…
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Humana’s Louisiana business received at least $10.5 million in Medicare Advantage overpayments in 2017 and 2018, according to an audit report from HHS’ Office of Inspector General. The audit, published in December, reviewed high-risk diagnosis codes including acute stroke, acute…
Evry Health CEO and co-founder Chris Gay thinks the health insurance industry could eliminate prior authorizations entirely, but only if providers meet insurers halfway. On the Becker’s Payer Issues podcast, he spoke about the technology and business model problems fueling…
Health plans were early adopters of AI, using it to streamline claims processing, support call centers and manage utilization. Now, they’re ramping up AI deployment to enhance member experience, improve care quality and reduce administrative costs, according to America’s Health…
Clever Care Health Plan is pairing its culturally competent care model with a new provider network partnership built around the lifestyle habits of the world’s longest-living populations. The partnership launches in 2026 and will connect Clever Care’s 40,000 Medicare Advantage…
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Neither bill proposing solutions to the impending ACA enhanced subsidy expiration survived a Dec. 11 Senate vote. While Senate Democrats advocated for a three-year ACA tax credit extension, Republicans pitched an alternative focusing on health savings accounts. Both motions failed…
CMS’s proposed Medicare Advantage rule for 2027 includes more leeway for hemp coverage. Hemp has low concentrations of tetrahydrocannabinol, as defined by the Agriculture Improvement Act of 2018. Under the proposal, hulled hemp seed, hemp seed protein powder and hemp…
Nearly 5.8 million people have enrolled in ACA marketplace plans for 2026 coverage, outpacing last year’s enrollment figures at the same point in the open enrollment period, according to new data published Dec. 5 by CMS. Americans have until Dec.…
The One Big Beautiful Bill Act will bring sweeping changes to Medicaid beginning in 2027, while enhanced ACA premium tax credits are set to expire at the end of this year, creating uncertainty for millions of enrollees. California stands to…
While Senate Democrats have been gearing up to vote on their ACA enhanced subsidy extension proposal on Dec. 11, Republicans are readying their own bill. “The way the program is structured, the money goes straight to the insurance companies,” Senate…