Payer

The CalOptima board of directors unanimously approved a $100 million, five-year strategic plan that includes implementing same-day treatment authorizations and real-time claims payments for providers.

A circuit court judge has sided with HHS over a payer's challenge to risk-adjustment rules, according to court documents filed March 17.

A March 18 brief from America's Health Insurance Plans recommends value-based care plans to improve maternal health outcomes and costs.

There is no correlation between CMS' Comprehensive Primary Care Plus Initiative and increased care continuity or decreased fragmentation of care among Medicare beneficiaries, according to a March 9 study in the American Journal of Managed Care.

CMS is proposing rules to the Office of Information and Regulatory Affairs that would impose fines of $1,000 per day against people and organizations that fail to report settlements with Medicare enrollees who allocate funds to future medical services, according…

In a first-time move, the Illinois Department of Insurance is fining Blue Cross Blue Shield of Illinois for failing to provide information to the state after its contract termination with Springfield Clinic.

It’s no secret that the HR function has become more complex in recent years. Thanks to policy changes in State Paid Sick Leave, the Affordable Care Act, demands brought forth by the #MeToo movement (among other changes), today HR professionals…

HHS says it's examining risk adjustment practices that may have led to billions in Medicare Advantage overpayments.

The American Medical Association is speaking out against a recent report from the Medicare Payment Advisory Commission that recommends a continuation of the freeze on Medicare physician fee payment rates.

A coalition of payers, health systems and public entities are partnering to boost health equity and outcomes in Philadelphia.