Aetna is rolling out new claims cost control measures under its Claim and Code Review Program, beginning Sept. 1. The new claims editing policy applies to commercial, Medicare and student health members, the company said in June. Aetna may trigger…
Payer Policy Updates
HHS and CMS are establishing a panel of experts tasked with providing recommendations on how to “improve how care is financed and delivered” across Medicare, Medicaid, the Children’s Health Insurance Program and the ACA’s exchanges. Members of the Healthcare Advisory…
The U.S. Office of Personnel Management will end coverage of gender transition-related surgeries and hormone treatments under the Federal Employees Health Benefits and Postal Service Health Benefits programs, beginning in 2026. In an Aug. 15 letter to carriers, OPM said…
Iowa will implement work requirements for its Medicaid expansion program beginning Jan. 1, 2026, Radio Iowa reported Aug. 19. Under the recently signed One Big Beautiful Bill Act, states will have to establish Medicaid work requirements for certain individuals, beginning…
New Hampshire Gov. Kelly Ayotte has signed legislation banning surprise ground ambulance billing and establishing reimbursement rates insurers must pay for services. Beginning Jan. 1, 2026, ambulance providers — whether in-network or out-of-network — will be prohibited from billing patients…
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Aetna is rolling out a new inpatient reimbursement policy for its Medicare Advantage and Special Needs Plans, effective Nov. 15. “Our goal is simple: We want to help you get reimbursed faster for inpatient admissions that are initially denied. You’ll…
The Trump administration has no current plans to require payers to provide coverage for in vitro fertilization services, despite a campaign pledge to do so, The Washington Post reported Aug. 3. Five things to know: 1. During his 2024 presidential…
New Hampshire Gov. Kelly Ayotte has signed a bill that requires insurers to notify the state’s insurance department at least 90 days in advance before discontinuing a line of business, including Medicare Advantage plans. The bill specifically mandates that insurers…
Oregon health officials are weighing a potential cap on commercial health insurance payments to hospitals in an effort to address rising costs, the Oregonian reported July 15. According to the report, the state’s Committee on Health Care Affordability has been…
On July 4, President Donald Trump signed the “One Big Beautiful Bill Act,” which includes major changes for employee benefits. Six notes: 1. Starting January 1, individuals enrolled in bronze and catastrophic ACA plans will be eligible to contribute to…