Medicare Advantage Signal Feed
Latest scored signals across all monitored sources.
1195 signals
-
AHA launches new website on prior authorization
As major provisions of the 2024 Centers for Medicare & Medicaid Services Interoperability and Prior Authorization Final Rule take effect on Jan. 1, 2027, hospitals and health systems are advised to begin preparing for significant changes to prior authorization workflows, payer interactions and information exchange. The AHA’s new website on prior authorization contains news and resources about prior authorization, both in general and as the final rule’s deadline approaches. The website will be...
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS reinstates some ACA enrollees after cutting 760,000 people
CMS has reinstated a small number of enrollees who lost coverage after the agency canceled ACA policies for more than 760,000 people, according to a KFF Health News report published Oct. 15 in NPR. KFF Health News learned of the reinstatements through insurance industry sources, finding that not all of those who lost coverage were […] The post CMS reinstates some ACA enrollees after cutting 760,000 people appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
Seniors Shouldn’t Have to Brace for Disruption Every October
As Medicare Open Enrollment Begins, Better Medicare Alliance Calls on Policymakers to Deliver Lasting Stability for Medicare Advantage Lower 2027 premiums show what stable funding can do. Rising out-of-pocket costs, … Continue reading "Seniors Shouldn’t Have to Brace for Disruption Every October" The post Seniors Shouldn’t Have to Brace for Disruption Every October appeared first on Better Medicare Alliance .
Membership Movement · 18 signals · last 30 days -
One Platform, Not Five Vendors: How Growing Health Plans Are Consolidating Payer Technology
Most health plans did not set out to build a patchwork of vendors. It happened one urgent need at a time: a risk adjustment tool here, a quality reporting platform there, a separate chart retrieval vendor, and yet another system for regulatory submissions. Each decision made sense on its own. Together, they leave a growing […] The post One Platform, Not Five Vendors: How Growing Health Plans Are Consolidating Payer Technology appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
Louisiana opens enrollment for 274,000 Medicaid recipients who must switch plans
Healthy Blue, offered by Blue Cross Blue Shield of Louisiana and Elevance Health, is pulling out of Louisiana’s Medicaid program at the end of the year.
Elevance Health + Blue Cross Blue Shield plans · 48 signals · last 30 days -
Centene unveils national provider gold card program
Centene is aiming to simplify the prior authorization process with the launch of a new nationwide gold card program.
CenteneCentene · 13 signals · last 30 days -
8 things to know about 2027 Medicare Advantage star ratings
CMS released 2027 Medicare Advantage star ratings on Oct. 8, giving more insight into the MA landscape beyond health plans’ marketing materials. Contracts receive a rating each year, ranging from one to five stars. The ratings help beneficiaries compare plans, but they also shape quality bonus payments to boost benefits. Four stars is the main […] The post 8 things to know about 2027 Medicare Advantage star ratings appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
Cigna accused of underpaying ground ambulances to boost its own fees
Cigna is facing a lawsuit claiming it made a profit by underpaying out-of-network ground ambulances, according to a class-action complaint filed Oct. 12 in a California federal court. The lawsuit centers on self-funded employer health plans that Cigna administers under administrative services only agreements. The plaintiff, who was covered by one of these plans, alleged […] The post Cigna accused of underpaying ground ambulances to boost its own fees appeared first on Becker's Payer Issues |...
Cigna CaliforniaCigna · 15 signals · last 30 days -
CMS takes aim at duplicative ACA, Medicaid enrollments
The Trump administration has put a focus on rooting out fraud, waste and abuse, and on Wednesday, regulators offered a look at progress to date in those efforts.
Policy / Regulatory Changes · 140 signals · last 30 days -
Trump Administration Delivers Second Year of Savings by Stopping Taxpayer Payments for Duplicate and Deceased Enrollees in Obamacare
Trump Administration Delivers Second Year of Savings by Stopping Taxpayer Payments for Duplicate and Deceased Enrollees in Obamacare After Years of Biden-era Inaction, CMS Reviews Projected to Save Taxpayers $1.5 Billion Over the Next Year The Centers for Medicare & Medicaid Services (CMS) continue to crush fraud, waste, and abuse in America’s healthcare programs by stopping duplicative enrollment in government health programs, with the potential to save taxpayers approximately $1.5 billion o...
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS can now exclude providers from Medicare, Medicaid: 7 things to know
CMS can now exclude individual providers and entities from participating in federal healthcare programs, including Medicare and Medicaid. HHS Secretary Robert F. Kennedy Jr. delegated the authority to the CMS administrator in a notice that took effect immediately. Here are seven things to know: 1. The notice was published in the Federal Register on Oct. […] The post CMS can now exclude providers from Medicare, Medicaid: 7 things to know appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS ends ACA subsidies for 189,000 duplicate or deceased enrollees: 5 notes
CMS ended subsidies in 2026 for 189,000 people with federally subsidized marketplace coverage who also had Medicare, Medicaid or Children’s Health Insurance Program coverage, or who were deceased, HHS said Oct. 14. Here are five things to know: 1. The Trump administration in 2025 restored duplicate enrollment enforcement and ended duplicate marketplace subsidies for about […] The post CMS ends ACA subsidies for 189,000 duplicate or deceased enrollees: 5 notes appeared first on Becker's Payer...
Policy / Regulatory Changes · 140 signals · last 30 days -
No Surprises Act arbitration awards near 6% of commercial medical spend in some regions: UnitedHealthcare
Arbitration awards under the No Surprises Act can reach nearly 6% of total commercial medical spend in some regions, UnitedHealthcare CEO Tim Noel said during an Oct. 13 earnings call. The medical cost trend for UnitedHealthcare’s commercial business is “exceeding” an initial expectation of 11%, Mr. Noel said. While Mr. Noel pointed to clinician cost […] The post No Surprises Act arbitration awards near 6% of commercial medical spend in some regions: UnitedHealthcare appeared first on Becker'...
UnitedHealthcareUnitedHealthcare · 46 signals · last 30 days -
CVS to pay $315M over opioid prescriptions billed to Medicare, federal programs: Justice Department
CVS Pharmacy has agreed to pay $315 million to resolve Justice Department allegations that it illegally filled opioid and other controlled substance prescriptions, according to an Oct. 13 news release. Here are five things to know: The post CVS to pay $315M over opioid prescriptions billed to Medicare, federal programs: Justice Department appeared first on Becker's Payer Issues | Payer News .
Competitive / Operational Strategy · 36 signals · last 30 days -
Insurers, AMA join forces on provider directory data standard
DataSpring, powered by CAQH, assembled a collective of insurers, along with the American Medical Association, to launch a new standard to measure provider directory data quality for individual clinicians on Oct. 13. DataSpring, owned by major health insurers, bridges payer and provider data. Along with DataSpring and the AMA, the Provider Data Collective includes Aetna, […] The post Insurers, AMA join forces on provider directory data standard appeared first on Becker's Payer Issues | Payer N...
AetnaCVS Health / Aetna · 12 signals · last 30 days -
CMS delegated exclusion authorities for Medicare, Medicaid
The Department of Health and Human Services has delegated the Centers for Medicare & Medicaid Services certain statutory authorities to exclude individuals and entities from federal healthcare programs, including Medicare and Medicaid, effective immediately, HHS announced in a Federal Register notice. The delegation grants CMS similar authority to exclude and permanently ban providers as the HHS Office of Inspector General has following investigations. “As the agency directly responsible for...
Policy / Regulatory Changes · 140 signals · last 30 days -
Optum Health’s turnaround picks up speed
Optum Health’s earnings from operations climbed to $735 million in the third quarter, up from $41 million a year earlier, as UnitedHealth Group’s care delivery arm continues to recover from a challenging 2025. The unit’s operating margin rose to 3.2% from 0.2%, according to UnitedHealth’s Oct. 13 earnings release. On an adjusted basis, the margin […] The post Optum Health’s turnaround picks up speed appeared first on Becker's Payer Issues | Payer News .
UnitedHealthOptumUnitedHealthcare · 46 signals · last 30 days -
AHA pushes back on Blue Cross report tying AI to $942M in coding costs
The American Hospital Association is challenging a Blue Cross Blue Shield Association analysis that estimated rising hospital coding intensity added $942 million in costs and linked the trend to AI-enabled billing tools. The AHA argued in an Oct. 5 blog post that rising coding intensity reflects older, more complex patients, not improper billing. The organization […] The post AHA pushes back on Blue Cross report tying AI to $942M in coding costs appeared first on Becker's Payer Issues | Payer...
Blue CrossBlue ShieldBlue Cross Blue Shield plans · 36 signals · last 30 days -
Trump Administration Announces New Funding to Support Early Career Physicians Who Choose to Work in Rural Delaware
Trump Administration Announces New Funding to Support Early Career Physicians Who Choose to Work in Rural Delaware This federal investment will award housing and assistance to help future physicians train and practice in rural communities, ensuring Delawareans get the care they need close to home.
-
Centene joins insurers waiving prior authorizations for top providers
Centene is the latest insurer to adopt a gold card program as states and the Trump administration push for prior authorization reform.
CenteneCentene · 13 signals · last 30 days -
Poll: 43 percent support 'Medicare for all'
Nearly 43 percent of Americans support the idea of “Medicare for all,” according to an Axios/Ipsos poll released Tuesday, as concerns over health costs mount ahead of the midterm elections. People who said they support Medicare for all outnumbered its opponents by a nearly 2-to-1 margin, while a bipartisan majority of Americans said they think the...
Financial / Operating Pressure · 30 signals · last 30 days -
CVS, DOJ reach $315M settlement in opioid prescription case
CVS Health has reached a $315 million settlement with the Department of Justice that resolves allegations the pharmacy giant knowingly filled unlawful opioid prescriptions.
CVS HealthCVS Health / Aetna · 12 signals · last 30 days -
Trump Administration Announces New Funding to Support Rural Healthcare Workers and Expand Maternal Care Across Missouri
Trump Administration Announces New Funding to Support Rural Healthcare Workers and Expand Maternal Care Across Missouri Federal investment will expand childcare support for rural healthcare workers and launch nurse midwife training to help address maternal care gaps across Missouri
-
STAT+: BlackRock to buy majority stake in Humana’s CenterWell clinics for $2.8 billion
Humana is swapping out private equity sponsors for its CenterWell Senior Primary Care clinics. Good bye, Welsh, Carson, Anderson & Stowe. Hello, BlackRock.
HumanaHumana · 13 signals · last 30 days -
CVS to pay $315M settlement over allegations of illegally filling opioid prescriptions
The Justice Department (DOJ) announced Tuesday that CVS Health has agreed to pay $315 million to settle lawsuits alleging the company illegally filled prescriptions for opioids and other controlled substances. The settlement resolves a lawsuit first filed in 2019 by former CVS employee Hillary Estright in 2019 under the whistleblower provision of the False Claims...
CVS HealthCVS Health / Aetna · 12 signals · last 30 days