Medicare Advantage Signal Feed
Latest scored signals across all monitored sources.
1195 signals
-
Amazon, Google among self-funded employers joining CMS' prior auth pledge
The Trump administration revealed Wednesday that five of the country's largest employers have signed on to expand electronic prior authorization in self-funded plans.
Policy / Regulatory Changes · 140 signals · last 30 days -
Integris Health to join Kaiser Permanente's Risant Health
Pending approvals, Oklahoma's largest nonprofit health system will follow in the footsteps of Geisinger Health and Cone Health in seeking outside investment and tech-enabled value-based care know-how from the Kaiser subsidiary.
Kaiser OklahomaKaiser Permanente · 4 signals · last 30 days -
CMS News: Trump Administration Announces $32 Million to Recruit Rural Doctors, Train Healthcare Workers and Expand Emergency Mental Healthcare Across Mississippi
Trump Administration Announces $32 Million to Recruit Rural Doctors, Train Healthcare Workers and Expand Emergency Mental Healthcare Across Mississippi This federal investment will help rural communities recruit healthcare professionals and establish three psychiatric emergency units to connect patients with timely behavioral healthcare
Policy / Regulatory Changes · 140 signals · last 30 days -
Horizon BCBS to acquire Summit Health’s New Jersey business
Horizon Blue Cross Blue Shield of New Jersey has agreed to acquire multispecialty physician group Summit Health’s New Jersey operations, including CityMD urgent care sites in the state, the insurer confirmed to Becker’s. “We are excited by the opportunity to preserve access to high quality care for all of Summit Health’s patients, improve healthcare quality […] The post Horizon BCBS to acquire Summit Health’s New Jersey business appeared first on Becker's Payer Issues | Payer News .
Blue Cross Blue Shield plans · 36 signals · last 30 days -
‘The market is reaping the benefits’ of BCBS antitrust settlement, Elevance says
Newly enabled competition between Blue Cross Blue Shield plans is continuing to contribute to Elevance Health’s commercial insurance business, leadership said on the company’s quarterly earnings call Oct. 21. Dubbed the “second blue bid,” the provision stems from a $2.67 billion settlement that resolved class action allegations dating back to 2012 that BCBS plans conspired […] The post ‘The market is reaping the benefits’ of BCBS antitrust settlement, Elevance says appeared first on Becker's...
ElevanceBlue CrossElevance Health + Blue Cross Blue Shield plans · 48 signals · last 30 days -
STAT+: CMS extends fraud crackdown to New York’s adult day care program
CMS is cracking down on adult day cares in New York, part of a broader focus on alleged health care fraud.
Policy / Regulatory Changes · 140 signals · last 30 days -
Oracle, Amazon, Google among employers backing federal prior authorization reform push
Amazon, Axon, Google, Meta and Oracle are asking the insurers and third-party administrators that run their health plans to expand electronic prior authorization upgrades, first promised under a 2025 federal pledge, to the self-funded market. CMS and the Labor Department announced the employers’ statement of support Oct. 21. Self-funded employer plans aren’t subject to the […] The post Oracle, Amazon, Google among employers backing federal prior authorization reform push appeared first on Bec...
Policy / Regulatory Changes · 140 signals · last 30 days -
Elevance’s new site-of-care rules puts hospitals on alert
As Elevance Health prepares to implement new site-of-care billing requirements, revenue cycle leaders are raising concerns about additional administrative burdens, potential payment delays and growing complexity across payers. “My broader concern is growing variation across payers, which adds cost and creates more chances for error,” Felix Segre, director of revenue integrity at Houston-based Memorial Hermann […] The post Elevance’s new site-of-care rules puts hospitals on alert appeared firs...
ElevanceElevance Health · 16 signals · last 30 days -
CMS defers $1.2B in Medicaid funds from California, puts New York on notice after raid
The Trump administration is withholding additional funds from California as part of its war with certain states over Medicaid fraud.
Policy / Regulatory Changes · 140 signals · last 30 days -
Baba nabs $40M series A, backed by FirstMark Capital and CVS Health Ventures, for AI-powered Medicare patient navigation
The AI company plans to use the funding to further its research, reach more health plans and accelerate value-based arrangements, executives say.
CVS HealthCVS Health / Aetna · 12 signals · last 30 days -
Leading Employers Back Expansion of Electronic Prior Authorization to Self-Funded Health Plans
Leading Employers Back Expansion of Electronic Prior Authorization to Self-Funded Health Plans New employer support increases momentum to modernize prior authorization, reduce administrative burden across employer-sponsored coverage
-
White House defers $1.2B more in California Medicaid payments
The White House is withholding another $1.2 billion in federal Medicaid payments to California, citing growth in the state’s personal care services spending. CMS Administrator Mehmet Oz, MD, made the announcement Oct. 20 in the Oval Office on behalf of HHS Secretary Robert F. Kennedy Jr. He pointed to concerns over California’s In-Home Supportive Services […] The post White House defers $1.2B more in California Medicaid payments appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
AHA comments to CMS on preliminary 2027 Medicare clinical laboratory fee schedule rates
The AHA submitted comments to the Centers for Medicare & Medicaid Services Oct. 21 on its preliminary calendar year 2027 Medicare clinical laboratory fee schedule rates. The AHA said the preliminary rates highlight the need for substantial reforms to CMS’ methodology, saying they are based on incomplete data. The AHA discussed the requirement under the Protecting Access to Medicare Act that called for hospital outreach laboratories and other clinical laboratories to report their private payer...
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS announces five organizations sign prior authorization pledge
The Centers for Medicare & Medicaid Services Oct. 21 announced that Amazon, Axon Enterprise, Inc., Google, Meta and Oracle Corp. are in support of its prior authorization pledge announced last year. The pledge involves streamlining prior authorization processes and increasing transparency for patients and providers by 2027. The AHA recently launched a new website on prior authorization, containing prior authorization news and resources. The website will be updated with additional resources an...
Policy / Regulatory Changes · 140 signals · last 30 days -
SCAN senior exec departs
Lindsay Crawley-Herbert left her role as chief people and transformation officer at SCAN, according to an Oct. 20 LinkedIn post. “Over the years, I’ve had the privilege of being part of an extraordinary evolution,” she wrote. “We’ve grown, transformed, taken on hard challenges and continued to raise the bar on what’s possible. We’ve built new […] The post SCAN senior exec departs appeared first on Becker's Payer Issues | Payer News .
SCANSCAN Health Plan · 12 signals · last 30 days -
New York payer says 2027 Medicare Advantage star rating will cost it $380M
Healthfirst is the latest insurer to sue the federal government in a bid to overturn its 2027 Medicare Advantage star rating it says will cost the plan more than $380 million. The New York City-based insurer, which has more than 300,000 MA enrollees, received a 3.5-star rating for 2027, down from 4.5 stars the prior […] The post New York payer says 2027 Medicare Advantage star rating will cost it $380M appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
Elevance reports $1.4B in Q3 profit, names Carelon president
Elevance Health logged nearly $1.4 billion in third-quarter profit for 2026, up 14.8% year over year. The company posted its earnings Oct. 21. That same day, Elevance named Jeff Park as president of healthcare services subsidiary Carelon, effective Dec. 1. Mr. Park was most recently president of health technology company Waltz Health. Along with other […] The post Elevance reports $1.4B in Q3 profit, names Carelon president appeared first on Becker's Payer Issues | Payer News .
ElevanceElevance Health · 16 signals · last 30 days -
Elevance Health posts $1.4B in profit in Q3 earnings beat
Elevance Health is boosting its outlook for the year as it beat Wall Street analysts' expectations for both profit and revenue in the third quarter.
ElevanceElevance Health · 16 signals · last 30 days -
Centene, Oscar, UnitedHealthcare sidle into some new counties in 2027 ACA plans
The major insurers are entering new Affordable Care Act markets as others are leaving the exchanges en masse, though in the cases of Centene and UnitedHealthcare, county additions paper over larger state exits.
UnitedHealthcareCenteneUnitedHealthcare + Centene · 58 signals · last 30 days -
Elevance sees Medicaid momentum in Q3
States jacked up their Medicaid rates in July, a positive development for the insurer. Elevance now thinks its Medicaid margin will be better than its prior expectation of -1.75% this year.
ElevanceElevance Health · 16 signals · last 30 days -
Privacy Act of 1974; Matching Program
In accordance with subsection (e)(12) of the Privacy Act of 1974, as amended, the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), is providing notice of a computer matching program between CMS and the Department of Veterans Affairs (VA), Veterans Health Administration (VHA). The purpose of the matching program is to identify beneficiaries enrolled in both Medicare and VHA health care and to identify medical claims for which both agencies made pay...
Policy / Regulatory Changes · 140 signals · last 30 days -
Centene, Oscar Health outline 2027 ACA marketplace plans
Open enrollment for the Affordable Care Act's marketplaces begins on Nov. 1, and with more turbulence on deck, insurers are offering a look at their plans for the coming year.
CenteneOscar HealthCentene + Oscar Health · 14 signals · last 30 days -
‘Now’s the right time’: Why an Idaho health system is launching a Medicare Advantage plan
Boise, Idaho-based St. Luke’s Health System will begin offering Medicare Advantage coverage for the first time in 2027, making it one of just a handful of new entrants into the market. The launch comes as more than a dozen payers nationwide, including several prominent health systems, have made the decision to stop offering MA plans […] The post ‘Now’s the right time’: Why an Idaho health system is launching a Medicare Advantage plan appeared first on Becker's Payer Issues | Payer News .
-
3 most feasible Medicare Advantage reforms: Study
As Medicare Advantage faces concerns regarding plan oversight, possible overpayments and care access, RAND researchers assembled experts to unpack potential reforms. Published in Health Affairs Oct. 5, the study consisted of two rounds with nearly 40 panelists. They rated 15 policy reform ideas on a nine-point scale. These ideas had high-level framing and were drawn […] The post 3 most feasible Medicare Advantage reforms: Study appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
SCAN partners with Mosaic’s CareMore on Medicare Advantage plan
SCAN Health Plan launched a Medicare Advantage HMO with CareMore Health, an integrated care delivery system and primary care provider under Mosaic Health, with coverage beginning Jan. 1. According to an Oct. 13 news release, CareMore Health Plan by SCAN will be available in California’s Los Angeles and Orange counties. Plan members will have access […] The post SCAN partners with Mosaic’s CareMore on Medicare Advantage plan appeared first on Becker's Payer Issues | Payer News .
SCAN CaliforniaSCAN Health Plan · 12 signals · last 30 days