Payer

The California Department of Managed Health Care announced Dec. 18 that it has fined 12 health plans a total of $1.9 million for lack of oversight of a contracted medical group, which led to improper denials and delayed care.

CMS issued a final rule Dec. 20 that aims to strengthen the integrity of state-based insurance exchanges under the ACA and includes separate billing for abortion services.

A Tennessee lawmaker is requesting the state comptroller to check if BlueCross BlueShield of Tennessee, the administrator of the state's employee health plan, is properly paying medical claims, according to the Chattanooga Times Free Press.

New York Life agreed to buy Cigna's group life and disability insurance arm for $6.3 billion, the companies said Dec. 18.

Bright Health, the health insurance startup run by the former CEO of UnitedHealth Group, has raised more than $1 billion after another big funding round, according to The Wall Street Journal.

The Navajo Nation is looking to launch its own managed care organization in New Mexico through an agreement with Molina Healthcare.

Nonprofit health insurers claimed Texas health officials violated state law by awarding multibillion-dollar Medicaid contracts to only for-profit payers, according to a lawsuit cited by The Texas Tribune.

The following payer executives changed their positions so far this month.

A suspended Medicaid program in North Carolina could dock $500 million from Centene's revenues next year, the health insurer said in its 2020 guidance.

Trent Haywood, MD, the former CMO of the Blue Cross Blue Shield Association, took a new role at a company providing benefit check and prior authorization technology to clinical labs, home infusion and providers at other alternative sites.