State Intelligence — Tennessee
Signals referencing this state across all sources.
10 signals
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CMS to expand IRF claim review demonstration to all facilities billing the jurisdiction that includes Alabama, Georgia, Tennessee
The Centers for Medicare & Medicaid Services announced Sept. 25 that it will expand the Inpatient Rehabilitation Facility Review Choice Demonstration to include all IRFs that bill Medicare Administrative Contractor Jurisdiction J, which generally includes Alabama, Georgia and Tennessee. The demonstration, which is currently active for IRFs in Alabama, California, Texas and Pennsylvania, subjects 100% of all Original Medicare IRF claims to either pre-claim or post-payment review. For IRFs newl...
Policy / Regulatory Changes · 140 signals · last 30 days -
UnitedHealthcare, TeamHealth settle $100M alleged upcoding case
UnitedHealthcare and TeamHealth have settled a lawsuit in which the insurer accused the physician staffing company of upcoding emergency department claims. The lawsuit was voluntarily dismissed with prejudice Sept. 24 in Tennessee federal court, according to court records. The dismissal comes after the payer and hospital staffing company told the court Aug. 11 they had […] The post UnitedHealthcare, TeamHealth settle $100M alleged upcoding case appeared first on Becker's Payer Issues | Payer...
UnitedHealthcare TennesseeUnitedHealthcare · 46 signals · last 30 days -
UnitedHealthcare, Team Health settle $100M fraud suit in Tennessee
A 2021 legal battle between UnitedHealthcare and Team Health was dismissed after the parties reached a settlement, per court documents.
UnitedHealthcare TennesseeUnitedHealthcare · 46 signals · last 30 days -
Tennessee received $59M in Medicaid overpayments: OIG
Tennessee’s Medicaid program claimed $59.3 million in federal reimbursement for case management services provided to children who did not qualify for them, the HHS Office of Inspector General said in an audit report published Sept. 23. The OIG’s recommendations are not final decisions, and CMS ultimately determines whether to pursue recovery. Six notes: The post Tennessee received $59M in Medicaid overpayments: OIG appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
Judge dismisses Ballad Health's MA claims denial lawsuit against UnitedHealth
Tennessee-based health system Ballad Health alleged the payer routinely denies or delays care physicians deemed necessary, and said it will continue to pursue the issue in arbitration as ordered by the court.
UnitedHealth TennesseeUnitedHealthcare · 46 signals · last 30 days -
Elevance’s Wellpoint taps COO for Tennessee
Kraig Dalton has joined Elevance Health’s Wellpoint as COO of its Tennessee health plan. “Supporting Tennesseans in need is deeply important to me, and I’m honored to take on this role leading operations at Wellpoint,” Mr. Dalton said in an August LinkedIn post. Mr. Dalton was most recently a director at Findhelp, a social care […] The post Elevance’s Wellpoint taps COO for Tennessee appeared first on Becker's Payer Issues | Payer News .
Elevance TennesseeElevance Health · 16 signals · last 30 days -
Medicare Advantage provider agrees to $2.4M false claims settlement
Tennessee-based in-home care provider Monogram Health has agreed to pay $2.4 million to settle allegations that it caused the submission of false diagnosis codes to boost Medicare Advantage payments. From Jan. 1, 2021, through Dec. 31, 2023, Monogram allegedly knowingly submitted diagnosis codes that were not clinically accurate, not supported by patients’ medical records, or […] The post Medicare Advantage provider agrees to $2.4M false claims settlement appeared first on Becker's Payer Issu...
Policy / Regulatory Changes · 140 signals · last 30 days -
BCBS Tennessee pivots away from AI program that monitored employee work
BlueCross BlueShield of Tennessee has moved away from AI software that monitored employee work, according to an Aug. 19 report from the Chattanooga Times Free Press. The insurer confirmed to Becker’s that it recently ended a pilot based on employee feedback. The company had been using Skan AI, a platform that observes workflows and business […] The post BCBS Tennessee pivots away from AI program that monitored employee work appeared first on Becker's Payer Issues | Payer News .
BCBS TennesseeBlue Cross Blue Shield plans · 36 signals · last 30 days -
Top Medicare Advantage plans for member satisfaction in 2026: JD Power
Blue Cross Blue Shield of Tennessee has the highest-ranked Medicare Advantage plan for member satisfaction in 2026, according to JD Power’s 12th annual Medicare Advantage study. The consumer insight firm published its annual ranking of the top MA plans in 12 markets on Aug. 18 after surveying more than 14,500 enrollees and evaluating plans on […] The post Top Medicare Advantage plans for member satisfaction in 2026: JD Power appeared first on Becker's Payer Issues | Payer News .
Blue Cross Blue Shield plans · 36 signals · last 30 days -
West Tennessee Healthcare expands critical care support through eICU Program in partnership with Philips and hellocare.ai
Jackson, TN - West Tennessee Healthcare is continuing to strengthen critical care services across the region through the expansion of its systemwide eICU program powered by Philips eCareManager and integrated with the hellocare.ai virtual care platform.