This February, BCBS Michigan shared how it will cut reimbursement by 50% for nonpreventive evaluation/management services with modifier 25 that were billed on the same day as procedure codes with global periods of zero, 10 or 90 days. However, the…
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Novant Health, a 19-hospital system headquartered in Winston-Salem, N.C., has partnered with the North Carolina State Health Plan — which is administered by Aetna — to expand access to “no-cost surgical care” for hundreds of thousands of plan members across…
Eli Lilly has launched Employer Connect, a platform that offers employers a direct route to offer Zepbound coverage to workers at a list price of $449 per month, bypassing traditional pharmacy benefits. The platform pairs employers with more than 15…
CMS reported a record of nearly 47,000 comments on its Medicare Advantage payment proposal for 2027. The insurer-backed Better Medicare Alliance, an MA advocacy group, hosted an executive summit March 3, featuring CMS Director of Medicare and Deputy Administrator Chris…
In recent months, payers across the country have tried tightening policies to get a better grip on evaluation/management coding. While payers often say the policies aim to control costs or combat fraud, these more restrictive policies are often met with…
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Network Health, a Wisconsin-based insurer owned by Froedtert ThedaCare Health, grew 37% during this past annual enrollment period to 126,000 total Medicare Advantage members, its second consecutive year of record growth. The plan also posted a 98% member retention rate.…
Sidecar Health members can now see a guaranteed price for nearly every physician visit in the U.S. before receiving care. The update covers all office visits nationwide, from primary care to specialists and therapists, as well as common add-on services…
Managed Medicaid plans have gone from above-target profit margins during the pandemic-era enrollment boom to aggregate underwriting losses, with early 2025 data suggesting the losses aren’t slowing, according to a February analysis from Wakely. The consulting group analyzed MCO financial…
Medicare Advantage enrollment grew less than 1% during this past annual enrollment period, but beneath that modest topline number was a dramatic reshuffling as national payers shed hundreds of thousands of members while smaller and regional plans posted some of…
On Feb. 25, Centene offered CMS seven Medicaid reforms that would allow managed care organizations to take the reins in targeting fraud, waste and abuse in Medicaid. The letter called on CMS to: 1. Permit proactive payment suspensions without a…