Payer: Page
-
Courtesy of UnitedHealth Group
Change Healthcare cyberattackChange says its largest claims clearinghouses coming back online
More than $14 billion in claims have been prepared for processing and will start flowing soon, the technology firm said Friday.
By Emily Olsen • Updated March 25, 2024 -
Joe Raedle via Getty Images
Biden proposes strengthening Medicare’s drug pricing power
The administration seeks to significantly increase the number of drugs each year that would be subjected to price negotiations under provisions of the Inflation Reduction Act.
By Kristin Jensen • March 7, 2024 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
TrendlinePayer/provider relationships
As M&A intensifies and companies embrace more holistic and value-based care models, partnerships have become more closely intertwined.
By Healthcare Dive staff -
Getty Images
Medicare Advantage beneficiaries receive fewer home health visits, study finds
Medicare Advantage beneficiaries were also less likely to improve self-care and mobility function, according to research published in JAMA Health Forum.
By Emily Olsen • March 5, 2024 -
Permission granted by Elevance Health
Elevance gains $190M on revised MA star ratings
It’s a positive development for the insurer, which sued the government earlier this year after its quality scores fell dramatically.
By Rebecca Pifer Parduhn • March 5, 2024 -
George Frey / Getty Images Plus via Getty Images
Change Healthcare cyberattackAlphV’s hit on Change Healthcare strikes a sour note for defenders
The ransomware group didn’t just regroup quickly after a law enforcement takedown. It carried out the worst attack on U.S. infrastructure to date, according to experts.
By Matt Kapko • March 4, 2024 -
Getty Images
Molina loses Medicaid contract in Virginia
It’s the second recent Medicaid state loss for Molina, despite executives expressing confidence about the insurer’s ability to retain contracts.
By Rebecca Pifer Parduhn • March 1, 2024 -
Permission granted by Elevance Health
Elevance launches weight management program, including GLP-1 monitoring
Elevance joins a growing list of insurers expanding their weight management offerings amid soaring demand for GLP-1 drugs.
By Sydney Halleman • Feb. 28, 2024 -
Courtesy of UnitedHealth Group
UnitedHealth under antitrust investigation by DOJ: reports
Regulators are reportedly looking into the massive healthcare conglomerate’s potential anticompetitive effects, including the relationship between its health insurer UnitedHealthcare and physician network Optum.
By Rebecca Pifer Parduhn • Feb. 28, 2024 -
Alex Wong via Getty Images
Lobby-funded study argues Medicare Advantage rate cuts are worse than CMS expects
Medicare Advantage payment per month per beneficiary could drop by 1% next year if regulators finalize rates as proposed, according to the analysis backed by the Better Medicare Alliance.
By Rebecca Pifer Parduhn • Feb. 27, 2024 -
Colin Campbell/Healthcare Dive
State attorneys general urge PBM reform
The letter, sent on behalf of 39 state attorneys general to leaders in Congress, comes as lawmakers consider legislation to regulate the pharmacy middlemen.
By Sydney Halleman • Feb. 23, 2024 -
Getty Images
Medicare Advantage plans provide less intensive post-acute care, study finds
The research found no differences in 30-day hospital readmissions or mortality, but the study’s authors said more analysis on patients’ long-term functioning was needed.
By Emily Olsen • Feb. 21, 2024 -
Alex Wong via Getty Images
CMS finalizes rule to cut Medicaid DSH payments for some hospitals
Under the new definition, hospitals can only receive disproportionate share hospital Medicaid reimbursements for beneficiaries who are primarily insured by the safety-net program.
By Susanna Vogel • Updated Feb. 22, 2024 -
Getty Images
No Surprises implementation created uptick in in-network claims: Fair Health
From the fourth quarter of 2021 to the first quarter of 2022, in-network care as a percentage of all national claim lines increased 2.3%, the nonprofit found.
By Rebecca Pifer Parduhn • Feb. 20, 2024 -
Getty Images
Deep DiveInsurers brace for continued Medicare Advantage medical costs
The big question coming out of the health insurance earnings season is how much elevated utilization among seniors is carrying over into 2024.
By Rebecca Pifer Parduhn • Feb. 20, 2024 -
Getty Images
Disputes over surprise billing continue to soar, new CMS data shows
Arbiters are mostly selecting the higher payment offer in billing dispute determinations. That suggests No Surprises could actually raise premiums for consumers, one health researcher said.
By Rebecca Pifer Parduhn • Feb. 16, 2024 -
CFO Editorial Staff
SCAN Group, CareOregon abandon merger plans
The insurers have dissolved their merger a little over a year after it was announced amid rising criticism from politicians and the public.
By Susanna Vogel • Feb. 15, 2024 -
Permission granted by Elevance Health
Blue Cross of Louisiana halts sale to Elevance
It's the latest setback for the $2.5 billion deal, which was proposed early last year but has struggled to close amid a lack of buy-in from state regulators.
By Rebecca Pifer Parduhn • Feb. 15, 2024 -
Getty Images
Private equity deals in Medicare Advantage decline, report finds
High interest rates and new regulations could be driving the slowdown, according to a report by the Private Equity Stakeholder Project.
By Emily Olsen • Feb. 14, 2024 -
Getty Images
Humana sued over alleged 340B underpayments in Medicare Advantage
Alabama-based Baptist Health argued the insurer had received a “windfall” due to illegal payment cuts in the 340B drug discount program.
By Emily Olsen • Feb. 13, 2024 -
Permission granted by Elevance Health
Elevance lays off more employees
The health insurer has quietly laid off thousands of employees since September, according to sources.
By Rebecca Pifer Parduhn • Feb. 13, 2024 -
Getty Images
FTC obtains $195M judgment against Simple Health for selling ‘sham’ insurance
The Florida-based insurer deceived tens of thousands of consumers into purchasing what they believed was comprehensive coverage, but instead amounted to a medical discount membership.
By Rebecca Pifer Parduhn • Feb. 12, 2024 -
Getty Images
Molina’s redeterminations losses reach 500K members
As for Medicare Advantage, the insurer said it expects proposed 2025 rates other payers have slammed as a cut would actually boost its benchmark rate.
By Rebecca Pifer Parduhn • Feb. 8, 2024 -
Courtesy of UnitedHealth Group
UnitedHealth COO Dirk McMahon to retire
McMahon is leaving after two decades at the insurer.
By Rebecca Pifer Parduhn • Feb. 8, 2024 -
Justin Sullivan via Getty Images
CVS cuts 2024 outlook on Medicare Advantage caution
The insurer on Wednesday joined its peers in slamming proposed MA payment rates as insufficient given the dogged increase in medical costs.
By Rebecca Pifer Parduhn • Feb. 7, 2024 -
Getty Images
AHA calls for more payer oversight in No Surprises dispute resolution
In comments on a proposed rule, the American Hospital Association argued regulators haven’t fully addressed how they’ll handle oversight for some situations, like when an insurer fails to pay after a dispute determination.
By Emily Olsen • Feb. 7, 2024
Previous
