Medicare Advantage Signal Feed
Latest scored signals across all monitored sources.
722 signals
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CMS Launches New State Toolkit to Protect Children with Autism, Strengthen Oversight of Applied Behavior Analysis Services
CMS Launches New State Toolkit to Protect Children with Autism, Strengthen Oversight of Applied Behavior Analysis Services Resource supports child-centered, evidence-based care while strengthening program integrity, protecting children from inappropriate treatment, and safeguarding Medicaid and Children’s Health Insurance Program (CHIP) resources
Policy / Regulatory Changes · 67 signals · last 30 days -
UnitedHealthcare to tighten reimbursement for lab tests
UnitedHealthcare is rolling out new reimbursement limits on five categories of lab tests across its commercial, ACA, Medicare Advantage and Medicaid plans. The five policies cover allergen testing, liver fibrosis testing, in vitro chemotherapy sensitivity assays, testosterone blood tests and vitamin B12 testing. The policies generally take effect Sept. 1 for commercial, exchange and MA […] The post UnitedHealthcare to tighten reimbursement for lab tests appeared first on Becker's Payer Issues...
UnitedHealthcareUnitedHealthcare · 34 signals · last 30 days -
Wisconsin insurer expands Cost Plus Drugs partnership
Network Health, the insurance arm of Wisconsin-based Froedtert ThedaCare Health, is expanding its partnership with Mark Cuban Cost Plus Drug Co. to include employer-sponsored health plan members. In early 2025, Network Health became one of the first insurers in the country to integrate Cost Plus Drugs into its Medicare Advantage pharmacy network. On Aug. 3, […] The post Wisconsin insurer expands Cost Plus Drugs partnership appeared first on Becker's Payer Issues | Payer News .
Competitive / Operational Strategy · 38 signals · last 30 days -
STAT+: Are AI scribes medical devices? UK regulator weighs in.
In this edition of STAT Health Tech: UK regulator on AI scribes, CMS eliminates key payment pathways for 'breakthrough' devices, and more.
Policy / Regulatory Changes · 67 signals · last 30 days -
DeepHealth gets FDA nod for AI tool that reads ultrasounds, creates reports
DeepHealth’s tool automates lesion detection, characterization and reporting from breast ultrasound scans.
SCANSCAN Health Plan · 11 signals · last 30 days -
Medicare for All and West Virginia
“Analyses show that administrative overhead, insurer profit margins, and PBM-related practices account for a significant share of premium spending. Roughly 16 cents of every premium dollar goes to profits and administrative costs, making overhead the second-largest category of premium spending.” — Rep. Carol Miller, R-W.Va. I agree 100% with Rep. Carol Miller. What I do […]
Financial / Operating Pressure · 13 signals · last 30 days -
What the latest Star Ratings turmoil says about the program
The Medicare Advantage Star Ratings program is rife with drama.
Policy / Regulatory Changes · 67 signals · last 30 days -
Healthcare Advisory Committee (HAC); Announcement of the HAC Meetings for Fiscal Year 2026-2027
This meeting notice announces the virtual meeting public components of the Healthcare Advisory Committee (HAC or Committee) for the fiscal year 2026-2027. The purpose of the Committee is to advise the Secretary of HHS and the CMS Administrator on programs and policies that can improve the United States healthcare system consistent with the Executive Order Establishing the President's Make American Healthy Again Commission. The virtual meetings are open to the public.
Policy / Regulatory Changes · 67 signals · last 30 days -
Why payers should have these 3 pipeline drugs on their radar
Optum Rx's latest look at the drug development pipeline highlights three drugs for rare and chronic conditions that payers and plan sponsors should be watching.
OptumUnitedHealthcare · 34 signals · last 30 days -
Cleveland Clinic, Zipline take flight with prescription drug drone delivery partnership
Cleveland Clinic and Zipline have taken to the skies with their drone-delivery partnership for prescription drugs. It marks the first long-term deployment of a prescription drug drone delivery by a health system, they said, with the first deliveries made last week in and around Beachwood.
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EmblemHealth, NYC reach $53M copay settlement with Medicare retirees
EmblemHealth and New York City have agreed to settle a class action over $15 copays the city imposed on Medicare-eligible retirees enrolled in its GHI Senior Care plan. The proposed settlement, filed July 30, caps the defendants’ liability at $53 million and locks in the copays at $15 through 2027. Five retirees and the NYC […] The post EmblemHealth, NYC reach $53M copay settlement with Medicare retirees appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 67 signals · last 30 days -
A record-breaking 34 women run world’s top 500 companies — 2 are payer CEOs
Fortune released its ranking of the world’s top 500 companies by revenue for fiscal 2025 on July 28. Out of those 500 companies, women lead 34. Among those are Gail Boudreaux and Sarah London, CEOs of Elevance Health and Centene, respectively. Elevance took the 31st spot on the list, and Centene claimed 32nd. Elevance was […] The post A record-breaking 34 women run world’s top 500 companies — 2 are payer CEOs appeared first on Becker's Payer Issues | Payer News .
ElevanceCenteneElevance Health + Centene · 21 signals · last 30 days -
Oklahoma system out of network with Aetna
As of Aug. 1, non-emergency, scheduled elective services provided by Oklahoma-based Norman Regional Health System are no longer in network for Aetna members. The update affects commercial, Medicare Advantage and administrative-services-only plans, with Medicaid excluded. Norman Regional said negotiations had been ongoing “for months.” “Across the country, healthcare providers are experiencing rising costs related to […] The post Oklahoma system out of network with Aetna appeared first on Beck...
Aetna OklahomaCVS Health / Aetna · 10 signals · last 30 days -
BCBS Michigan to face proposed class action over shared savings fees
A federal judge has ruled that Blue Cross Blue Shield of Michigan must face a proposed class action accusing it of profiting from billing mistakes at the expense of the employers whose health plans it administers. Judge Robert Jonker of the U.S. District Court for the Western District of Michigan denied the insurer’s motion to […] The post BCBS Michigan to face proposed class action over shared savings fees appeared first on Becker's Payer Issues | Payer News .
Blue Cross Blue Shield plans · 20 signals · last 30 days -
Readout: CMS Celebrates Delivery of the Health Technology Ecosystem, One Year After Launch
Readout: CMS Celebrates Delivery of the Health Technology Ecosystem, One Year After Launch The Centers for Medicare & Medicaid Services (CMS) recently hosted the one-year celebration of the Health Technology Ecosystem, bringing together leaders from the government, healthcare, and technology sectors to feature the significant progress made over the past year in advancing interoperability, improving health data sharing, and expanding patient access to digital health tools.
Policy / Regulatory Changes · 67 signals · last 30 days -
‘These negotiations take on a whole different meaning’: Sentara seeks 6.2% hike, Anthem BCBS offers 1% cut
Norfolk, Va.-based Sentara Health is seeking a 6.2% blended reimbursement increase from Anthem Blue Cross and Blue Shield of Virginia for 2027. The insurer countered with an approximately 1% decrease, according to Sentara Executive Vice President and Chief Administrative Officer Aubrey Layne Jr. The gap has pushed the organizations closer to a potential split after […] The post ‘These negotiations take on a whole different meaning’: Sentara seeks 6.2% hike, Anthem BCBS offers 1% cut appeared...
Elevance Health + Blue Cross Blue Shield plans · 29 signals · last 30 days -
Rethinking RCM in an era of payer complexity and AI
Revenue cycle management has historically been labor intensive, demanding work. What has changed is the pace at which it is getting harder.
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22 states sue to block 2027 ACA marketplace rule
A coalition of 22 states are suing to block key pieces of CMS’ 2027 ACA marketplace rule, arguing the changes will push consumers into “barebones” coverage and revive provisions a federal court previously struck down. The complaint, filed July 31 in the U.S. District Court for the Northern District of California, is being co-led by […] The post 22 states sue to block 2027 ACA marketplace rule appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 67 signals · last 30 days -
Federal Excise Tax Revenues
CBO describes excise taxes, examines trends in excise tax revenues, and provides information about the models it uses for its baseline projections of excise tax revenues.
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STAT+: Is there a pharma mega-merger in the making?
Moderna's imminent FDA vaccine decision, TCGX launches $400M Asia biotech fund, and more biotech news
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STAT+: Pharmalittle: We’re reading about AstraZeneca-Bristol merger talks, a revised 340B plan, and more
AstraZeneca stock fell as investors balked at reports of merger talks with Bristol Myers Squibb about forming one of the world's biggest drugmakers
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Medicaid Expansion’s Growing Improper Enrollment Crisis: Nearly Half of Expansion Enrollees Likely Do Not Meet Eligibility Requirements
The post Medicaid Expansion’s Growing Improper Enrollment Crisis: Nearly Half of Expansion Enrollees Likely Do Not Meet Eligibility Requirements appeared first on Paragon Health Institute .
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Hospitals promise AI partnership. Nurses want it in writing
Nurses in New York and California have secured multiyear labor contracts with provisions ensuring they have a say in how AI is deployed.
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OMB's proposed grantmaking rule will destabilize biomedical research, experts warn
A proposed rule from the Office of Management and Budget to revise the federal grantmaking process is drawing widespread opposition from across multiple industries. Members of the medical research community warn the additional red tape will only serve to impede U.S. biomedical research. The Office of Management and Budget published a proposed rule in May that would, among several actions, instate a pre-issuance...
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Kennedy, Oz Contend Fraud Crackdown, Not Skyrocketing Prices, Led Millions To Leave Obamacare
Rising premiums forced many people in Affordable Care Act plans to give up their coverage. But the Trump administration claims a huge drop in enrollment is almost entirely due to its fraud crackdown.