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Senators urge CMS to collect more Medicare Advantage data
A bipartisan group of senators say lawmakers don't have enough data on Medicare Advantage to properly oversee the program. -
How BCBS plans are putting price transparency data to work
It's been nearly two years since payers have been required to publish the costs of their in-network provider rates for covered items and services, and now Blue Cross Blue Shield plans are using that data to create actionable insights for stakeholders across the healthcare system. -
Medical groups push back on Cigna policy change
Medical societies representing 95,000 members have expressed their "profound objection" to Cigna's characterization of closed-loop spinal cord stimulation therapy as "experimental, investigational, and/or unproven." -
CMS to crack down on Medicaid redetermination compliance
CMS has laid out how it will sanction states that do not comply with Medicaid redetermination requirements. -
Presidential candidates are setting their sights on the ACA. Are voters?
The Affordable Care Act is back in the political spotlight, but few voters have the future of the law at the top of their lists of issues to address, according to a KFF poll published Dec. 1. -
UnitedHealthcare updates home health prior authorization review process
UnitedHealthcare is updating its prior authorization and concurrent review process for home health services that are delegated to Home & Community Care, the payer's home care division. -
Bipartisan anger over Medicare Advantage denials on the rise
Concerns about Medicare Advantage denials are on the rise in Washington, Politico reported Nov. 24. -
CMS pitches new regulations for state-run exchanges: 5 things to know
CMS is proposing several new regulations for the ACA marketplace in 2025, including tighter regulation of state-based marketplaces. -
House subcommittee passes Medicare bills: 3 things to know
The Health Subcommittee of the Energy and Commerce Committee passed 21 health bills on to the full committee, including bills aimed at increasing Medicare Advantage transparency. -
Legislation would up Medicare Advantage transparency standards
A bipartisan group of senators is introducing legislation that would require Medicare Advantage plans to report more encounter data. -
Medicare Advantage ads still under CMS scrutiny
From October to December, airwaves are flooded with advertisements for Medicare Advantage plans, urging beneficiaries to call and review their options. -
'Worse than people can imagine': 5 Medicaid redeterminations updates
It's been more than seven months since the first states began the process of unwinding the continuous Medicaid enrollment period in place for three years during the pandemic, resulting in state agencies and beneficiaries reporting major operational challenges and exacerbated care access issues. -
Why BCBS Massachusetts is cutting 14K prior authorization requirements
Blue Cross Blue Shield of Massachusetts' plan to remove 14,000 prior authorization requirements for home care services is a response to the capacity crisis in the state's hospitals, the payer's chief medical officer Sandhya Rao, MD, told NPR affiliate WBUR Nov. 8. -
CMS proposes new Medicare Advantage audit appeals process
CMS is proposing a standard appeals process for risk adjustment data validation audits in Medicare Advantage. -
CMS proposes more crackdowns on Medicare Advantage marketing, broker payments
CMS is proposing a set of new Medicare Advantage rules, including new standards that would impose more limits on plans' payments to brokers and limit the role of third-party marketers. -
CMS proposes health equity mandates for Medicare Advantage prior authorizations
CMS is proposing new health equity changes for prior authorization policies and procedures at Medicare Advantage organizations to better determine any disproportionate impact on underserved populations that may delay or deny access to services. -
BCBS Massachusetts to cut 14,000 prior authorization requirements
Blue Cross Blue Shield of Massachusetts is removing 14,000 prior authorization requirements for home care services for its 2.6 million commercial members beginning Jan. 1. -
UnitedHealthcare's 2nd wave of prior authorization cuts begins
The second and final wave of UnitedHealthcare's prior authorization cuts began Nov. 1. -
Private payer's prices highest in upper Midwest and Southeast, price transparency study finds
Payers' negotiated prices for office visits and medical services can vary widely from county to county, according to a price transparency study published Oct. 27 in JAMA Health Forum. -
Senators want to bust Medicare Advantage 'ghost' networks
Lawmakers are introducing a bill to crack down on inaccurate provider directories in Medicare Advantage.
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