Payer

Common misconceptions about prior authorizations include how they are decided and their purpose, payer executives told Becker's.  

Short-term insurance plans can be valuable for those comfortable with high-deductibles in need of basic coverage, Victoria Eardley wrote in a July 21 opinion for The Wall Street Journal. 

Physicians who serve more patients dually eligible for Medicare and Medicaid and with higher risk scores are less likely to be included in Medicare Advantage networks, a study published July 21 in JAMA Health Forum found. 

Employer-sponsored insurance plans with fully-integrated medical and pharmaceutical benefits can lower medical costs and reduce hospitalization and emergency room visit rates, according to a report from Blue Cross Blue Shield of Minnesota and Prime Therapeutics. 

The CEO of a laboratory company acquitted in a $1.4 billion fraud scheme is suing six payers, alleging they made false allegations to regulators and prosecutors to avoid paying millions in legitimate claims.

Elevance Health beat investor expectations in its latest earnings report and is adding new food-as-medicine initiatives. 

The neighborhood an individual lives in can affect their healthcare utilization, especially in the Medicare population, according to a study in the American Journal of Managed Care. 

Some healthcare industry leaders are pushing to make California's largest-ever investment in Medi-Cal permanent, KFF Health News reported July 21. 

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: