Payer

Jersey City, N.J., Mayor James Solomon has hired an auditor to review health insurance claims paid by Horizon BCBS New Jersey, according to a March 17 news release. Horizon previously served as the city’s third-party health insurance administrator. The insurer…

HSS’ Office of Inspector General estimates that BCBS Alabama received at least $7 million in Medicare Advantage overpayments, according to a March audit report. From a sample of 271 enrollee-years, 247 had medical records that did not align with diagnosis…

Optum Health is about four months into a leadership transition, with its new CEO Krista Nelson laying out her vision for what the care delivery giant looks like after years of rapid expansion that company leadership has acknowledged steered the…

The Trump administration is widening its Medicaid fraud crackdown to Florida, with CMS sending a letter March 17 to Gov. Ron DeSantis and other state leaders that requests information on how the state identifies, prevents and addresses Medicaid program integrity…

Jessica Lopez-Liggett was named commercial state plan president for Anthem’s Indiana business in February, coming at a time when employers nationally are contending with the highest increase in benefits costs in at least a decade. Now about a month in,…

BCBS Illinois has plans to bolster its claims editing and review procedure, the insurer said March 16. The process will change July 1 for office, inpatient and outpatient evaluation and management services. If the billed services do not align with…

UnitedHealthcare is expanding doula coverage to eligible employer-sponsored plans nationwide. “UnitedHealthcare now will be the first to offer doula support in employer-sponsored and commercial members at this scale across plans nationwide,” Rhonda Randall, DO, chief medical officer for the insurer’s…

A Kansas Senate bill introduced in February is aiming to broaden Children’s Health Insurance Program eligibility in the state. SB 271 strives to raise the income threshold for CHIP eligibility from 250% of the federal poverty line, removing the prior…

On March 12, Indiana Gov. Mike Braun signed a bill that would transfer nursing home residents with a stay duration of at least 100 days from Medicaid managed care to fee for service. The transitions will begin July 1, 2027.…

Healthcare has invested heavily in behavioral health over the past decade. Networks have expanded, telehealth access has grown, and spending continues to rise. Yet outcomes remain stubbornly inconsistent. Nearly one-in-four Americans experienced a mental health challenge last year, and one-in-ten…