A group of Pennsylvania lawmakers is introducing legislation to require payers' to disclose how they use AI in claims review and require human review of any AI-processed claims.
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CMS warned 36 states they were not meeting federal requirements for Medicaid call center wait times, application processing timelines and rates of procedural terminations.
Presbyterian Health Plan received an estimated $2.2 million in Medicare Advantage payments in 2017 and 2018, according to an audit from HHS' Office of the Inspector General.
From posting 24.6 percent net income growth in the second quarter, to projecting adding $1.8 billion in premium revenue from its acquisition of Bright Health's Medicare Advantage business, here are 10 updates on Molina Healthcare that Becker's has reported since…
Bend, Ore.-based St. Charles Health System is considering dropping all Medicare Advantage plans and is encouraging its senior patients not to enroll in the private Medicare plans during the next open enrollment period.
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A New York State Supreme Court judge has permanently blocked the implementation of New York City's plan to switch 250,000 retired city employees from traditional Medicare to an Aetna Medicare Advantage plan.
Former employees with UnitedHealth Group's Optum and its subsidiaries have taken to social media in August regarding an unknown number of layoffs they say are occurring across the company.
Medicare Advantage plans are set to receive $12.8 billion in bonus payments from CMS in 2023, and representatives are introducing new legislation aimed at reforming prior authorization in the program.
A House bill has been introduced that aims to alleviate staffing shortage at state Medicaid agencies so beneficiaries do not lose coverage due to procedural issues during the redetermination process.
From lawmakers unveiling gold-card legislation to UnitedHealthcare detailing plans to cut 20 percent of requirements, here are six prior authorization updates Becker's has reported since July 26: