Payer

Value-based physician platform Aledade has partnered with several of the nation's largest payers over the last year.

From the HHS Office of Inspector General raising concerns over denial rates to Health Care Service Corporation expanding its use of AI technology, here are four updates on prior authorization reported by Becker's since July 13:

Audits from HHS' Office of Inspector General published in the first half of 2023 found over $56 million in estimated overpayments to Medicare Advantage providers. 

As of July 19, more than 3 million people have been disenrolled from Medicaid during the unwinding of the Medicaid continuous enrollment provision, according to KFF. 

Expensive GLP-1 drugs are just one of many factors driving up medical costs, Elevance Health CFO John Gallina said. 

Elevance Health is scaling new uses for artificial intelligence.

Molina Healthcare had the highest overall prior authorization denial rates in 2019 among the seven largest Medicaid managed care organizations, according to an audit from HHS' Office of Inspector General. 

CMS has required around a half-dozen states to pause procedural terminations to correct errors through the Medicaid redetermination process, CMS officials told reporters on a July 19 press call. 

Elevance Health is expecting many members who have lost Medicaid to transition to other forms of coverage, executives told investors on a second-quarter earnings call. 

California's health plan costs for state employees and retirees are rising at an "unsustainable" rate, state officials said.