Payer

In most regions in the U.S., Medicare dollars for inpatient services are concentrated among just a few hospital systems, an analysis from the Commonwealth Foundation found. 

As older Americans become a larger percentage of the population, using technologies — especially wearable devices — to help support health and wellness is growing in popularity. Monitoring exercise and nutrition and sending alerts related to chronic illness can often…

More payers won coveted Medicaid managed contracts when California reversed course on its August decision to award just three payers contracts to run its Medicaid program. The state announced a revised decision Dec. 30, granting more payers contracts. 

Five states represent the majority of where No Surprises Act disputes occurred between April 15 and Sept. 30, according to CMS' initial report on the independent dispute resolution process. 

The Pennsylvania Insurance Department ordered Capital Blue Cross to pay restitution plus interest for wrongly denied claims, in addition to an $85,000 fine, pennlive.com reported Jan. 4. 

Optum is hiring 1,400 employees from Brewer, Maine-based Northern Light Health and will manage parts of the system's operational functions.

HHS is giving states greater flexibility to cover social determinants of health initiatives under their Medicaid program. 

Several Blue Cross Blue Shield companies have formed a medication contracting organization, Synergie Medication Collective, aimed at reducing high specialty drug costs. 

A case filed by two former UnitedHealth executives who sued the company for allegedly underpaying them for a billion-dollar business line they helped create has quietly closed, the Minneapolis/St. Paul Business Journal reported Jan. 3. 

Reviewing and approving  prior authorizations has been a necessary but often cumbersome challenge.