Payer

The House passed a bipartisan healthcare funding package Jan. 22. The most recent version includes a provision addressing Medicare coverage for multi-cancer early detection screenings. The bill is now in the Senate’s hands. If it passes, Medicare beneficiaries would also…

Ten providers recently posted job listings seeking leaders in payer contracting and relations. Note: This is not an exhaustive list. Listings were compiled from job-seeker sites. 1. Aspirus, based in Wausau, Wis., seeks a vice president of payer contracting and…

Active-duty family members enrolled in Tricare Prime Remote will no longer face copays when filling covered prescriptions, according to a Jan. 27 news release from the military’s healthcare program. Tricare Prime Remote is a managed care offering for military families…

Medicare Advantage has long been viewed as a strong alternative to traditional Medicare, but the program has “deteriorated significantly” in recent years — benefitting commercial payers at the expense of patients and providers, according to Providence President and CEO Erik…

Forty-eight states, plus the District of Columbia, have been offering continuous Medicaid coverage for one year postpartum — but states do not always set clear expectations for how their managed care organizations can support this population. In 2021, states were…

Bloomington, Minn.-based HealthPartners and Quartz are working together on self-funded health plan options for employees. Large, commercial employers across Minnesota and Wisconsin will have coverage options that offer robust administrative resources, as well as strong regional and national provider networks.…

CMS proposed its 2027 Medicare Advantage and Part D capitation rates and payment policies Jan. 26, putting forth a slowdown in payment growth after a $25 billion boost for 2026. Six things to know:

Settling into 2026, prior authorization continues to be a contentious topic for payers, providers, lawmakers and other leaders. From piloting prior authorization in Medicare to governors pitching reforms, this year is already featuring major shifts. Here are seven prior authorization…

Dane Street is now certified as a federal independent dispute resolution entity, CMS said in a Jan. 26 email. The No Surprises Act intends to prevent surprise billing through its IDR process, which is designed to settle payment disputes between…

Republican Gov. Greg Abbott is pressing the Texas HHS Office of the Inspector General and HHS Commission to investigate the state’s Medicaid program for fraud, according to a Jan. 16 letter. The push comes weeks after the federal HHS froze…