Payer

The number of adults in a Medicaid-enrolled family that are unaware of impending redeterminations remains high across the nation.

A group of 70 lawmakers is pressing CMS on further Medicare Advantage reforms, and the agency is considering implementing prior authorization reforms and other changes to the program. 

The Indiana Department of Insurance tapped data management and analytics firm Onpoint Health to administer the state's All Payer Claims Database. 

Arkansas Gov. Sarah Huckabee Sanders is asking the federal government for a waiver to create work requirements for the state's Medicaid program, CBS affiliate KTHV reported Feb. 15. 

UnitedHealthcare added the most Medicare Advantage members in 2022 among the largest payers. Every payer except Cigna added members in 2022 to their Medicare Advantage plans. 

A federal judge granted Cigna a temporary restraining order in its lawsuit alleging former executive Amy Bricker's departure for rival CVS Health violated a noncompete agreement, Bloomberg Law reported Feb. 15. 

Initial clinical denial rates rose in 2022 with the highest denial rates coming from Medicare Advantage plans, according to a Feb. 15 report from Crowe Revenue Cycle Analytics.

Provider groups praised proposed CMS regulations to overhaul prior authorization in Medicare Advantage, one of many proposed and final changes from the agency. Payer groups are concerned about potential star ratings changes, tougher auditing standards and potential changes to reimbursement…

BlueCross BlueShield of Tennessee is digging into the data behind health equity, publishing its first ever health equity report to bring together public data and data from BCBS Tennessee members. 

A few Medicaid managed care plans have hired or are planning to hire more staff to process Medicaid redeterminations, a survey of plans by Kaiser Family Foundation found.