Payer

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

Perceived cost is the main barrier to uninsured individuals seeking health coverage on state marketplaces, a survey from Florida Blue found. 

Some methadone treatment providers are concerned Medicare Advantage prior authorization delays are preventing beneficiaries from receiving necessary treatments in time, Roll Call reported Jan. 4. 

Centene boosted its projected earnings per share for 2024 after scoring more Medicaid managed care contracts in California. 

Wells Fargo analysts downgraded Cigna from "overweight" to "equal weight" rating, favoring the payer's competitors, Seeking Alpha reported Jan. 3. 

Ten payers are involved in 85 percent of all disputes involving out-of-network emergency and nonemergency items in services under the No Surprises Act's independent dispute resolution process, according to a recent CMS report. 

Amerigroup Maryland, an Elevance Health subsidiary, has rebranded as Wellpoint Health. 

Medicare Advantage plan Cigna HealthSpring of Tennessee received $5.9 million in overpayments from the federal government in 2016 and 2017, according to an HHS Inspector General's Office audit. 

From investing in VillageMD's acquisition of Summit Health, to being sued by the Justice Department for allegedly making its Medicare Advantage members appear sicker than they were, here are eight key headlines about Cigna Becker's reported in 2022:   

A Florida judge is recommending that lawyers who settled a class action lawsuit against Humana and healthcare analytics company Cotiviti receive a lower fee than they asked for, Bloomberg Law reported Dec. 29.