Healthcare is constantly transforming, and payment integrity programs are facing unprecedented challenges fueled by rising medical spend, an evolving and unpredictable regulatory environment and increasing stakeholder expectations. These trends, coupled with a rapidly accelerating technology landscape, bring payment integrity to…
Payer
With healthcare constantly changing and health plans facing unprecedented challenges, payment integrity is at a critical inflection point. At Optum, we’re defining the future of payment integrity as payment precision—helping health plans achieve payment accuracy at claim submission. By advancing…
St. Louis-based Mercy is targeting closer partnerships with fewer organizations, Gavin Helton, MD, president of primary care at the system, told Becker’s. One of these partnerships is with Humana. Mercy and Humana opened their first collaborative 65Prime+ Clinics in Springfield…
CMS and the Department of Homeland Security have entered an agreement that will enable Immigration and Customs Enforcement officials to access the personal data of the nation’s 79 million Medicaid members, according to an exclusive report from The Associated Press. …
HHS says it has launched a study into “misleading” Medicare Advantage marketing practices “and the harms they cause to individuals.” “In recent years, concerns about aggressive and deceptive marketing practices in Medicare Advantage have become more pressing,” the HHS OIG…
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Insurers are requesting the highest ACA premium increases since 2018, according to an analysis by the Peterson-KFF Health System Tracker published July 18. Insurers are requesting a median increase of 15% based on preliminary rate filings. KFF analyzed rate increase…
CMS will not approve any new waivers for states to allow continuous enrollment for Medicaid or CHIP beneficiaries longer than 12 months. CMS has “concerns about the appropriateness of providing continuous eligibility,” said Drew Snyder, deputy CMS administrator and director…
CMS says it has identified 2.8 million Americans that have possibly either enrolled in Medicaid or CHIP in multiple states or have simultaneously enrolled in both Medicaid/CHIP and a subsidized ACA plan. The agency examined 2024 program enrollment data and…
Ten providers recently posted job listings seeking leaders in payer contracting and relations. Note: This is not an exhaustive list. Listings were compiled from job-seeker sites. 1. ChristianaCare, based in Newark, Del., seeks a senior director of managed care contracting…
Elevance Health is the latest insurer to cut its 2025 earnings guidance, citing elevated costs in the individual market and Medicaid. The company reported its second-quarter earnings July 17. Elevance Health earned $2.4 billion in operating income in the second…