1+ day, 7+ hour ago  (535+ words) Christian Delbert - stock. adobe. The California Hospital Association has taken legal action against a recent policy from Elevance Health that penalizes provider organizations for using out-of-network physicians for non-emergency care. CHA announced on Tuesday that it filed a lawsuit against…...

2+ day, 7+ hour ago  (843+ words) United Healthcare is keeping the momentum rolling with prior authorization reform, promising even more reductions by year's end. United announced today that it plans to reduce prior authorizations by another 30% in 2026. The payer was also part of a group of…...

6+ day, 15+ hour ago  (316+ words) Baurzhan Ibrashev/istock via Get CMS made inappropriate payments, totaling $2. 2 million, for virtual care services between 2019 and 2022, according to a new audit report by the HHS Office of Inspector General. For the audit, the OIG assessed CMS payments for virtual…...

1+ week, 3+ day ago  (502+ words) elenabs/istock via Getty Images Healthcare payers are serious about prior authorization reform, with leading health plans now promising to adopt a standardized electronic request process for most medical services. America's Health Insurance Plans (AHIP) announced on Friday that major…...

1+ week, 6+ day ago  (915+ words) Ca-ssis/istock via Getty Images CMS is no longer moving forward with the Medicare Part D component of the Better Approaches to Lifestyle and Nutrition for Comprehensive h Ealth, or BALANCE, Model, according to a memo sent on Tuesday. Announced…...

4+ week, 18+ hour ago  (808+ words) Leading healthcare payers said they have pared back prior authorizations after taking a pledge last year to simplify the notoriously cumbersome process. America's Health Insurance Plans (AHIP) and the Blue Cross Blue Shield Association (BCBSA) reported yesterday that participating payers…...

1+ mon, 7+ hour ago  (662+ words) Plans participating in Medicare Advantage will get a larger payment increase than originally planned, according to the finalized 2027 Rate Announcement. Yesterday, CMS released the rate announcement for Medicare Advantage (MA) capitation rates and Parts C and D payment policies for…...

1+ mon, 17+ hour ago  (1050+ words) Christian Delbert - stock. adobe. CMS has proposed Medicare payment updates for four types of provider organizations, including skilled nursing facilities. On April 2, the federal agency released four proposed payment rules for skilled nursing facilities (SNFs), hospices, inpatient rehabilitation facilities (IRFs)…...

1+ mon, 3+ week ago  (582+ words) Aetna has agreed to pay $117. 7 million to resolve allegations that it violated the False Claims Act by submitting inaccurate or untruthful diagnosis codes for its Medicare Advantage Plan enrollees, according to a Department of Justice press release. The alleged practice…...

2+ mon, 1+ week ago  (593+ words) Christian Delbert - stock. adobe. Medicare Advantage enrollment growth is continuing its downward trend, with new Chartis numbers showing enrollment grew only 2. 5% this year, compared to the 3. 6% seen in 2025 and the historic 7% growth in the early 2020s. All said, Medicare Advantage enrollment…...