Nevada Gov. Joe Lombardo and the Nevada Department of Health and Human Services have announced the launch of the Nevada Health Authority, effective July 1. The NVHA consolidates the state’s Medicaid program, ACA exchange, and public employees’ benefits program under…
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Elevance Health has agreed to a $12.9 million settlement to resolve a class action lawsuit that accused the company of improperly denying coverage for residential treatment of mental health and substance use disorders. The lawsuit was originally filed in April…
Centene has pulled its earnings guidance for 2025, citing higher aggregate ACA market morbidity. In a July 1 regulatory filing, Centene said it received data from consulting firm Wakely indicating overall marketplace growth in 22 of its 29 marketplace states…
Ohio ended GLP-1 coverage for weight loss under its state employee health plan on July 1. Any current prior authorizations for medications will be honored until they expire, and GLP-1 medications prescribed for diabetes will continue to be covered. Several…
The business case for embracing electronic prior authorization, or ePA, nationwide seems overwhelming. Current prior authorization processes are a chief driver of provider and patient frustration. Needed investment in FHIR APIs is now mandated by CMS Rule 0057, and ePA…
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AI is driving a transformative shift in healthcare, and 2025 may be its “ChatGPT moment.” As the healthcare system faces rising costs, workforce strain and pressure to deliver better outcomes, AI is moving from hype to practical impact. The success…
A real-time data initiative helped Healthfirst improve follow-up rates for patients visiting emergency rooms for mental health and substance use conditions. A national challenge for the industry is that relying on claims data alone is not fast enough to ensure…
The Cigna Group is granting 24 health organizations funding to support youth mental health projects. Here are three things to know: See the full list of grantees here.
Blue Shield of California is cutting broker commissions for new enrollments into Medicare Advantage PPO plans in Alameda, Orange and San Diego counties, effective July 1. The new policy does not affect commission payments of existing membership, according to a…
In June, around 50 insurers pledged their commitment to a set of voluntary actions aimed at simplifying the prior authorization process. The group of insurers, backed by leaders including CMS Administrator Mehmet Oz, MD, said they will work to implement…