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Beckerspayer.com

thumbnail favicon beckerspayer.com —  10+ hour, 56+ min ago

CMS needs more data on Medicare Advantage supplemental ...

beckerspayer.com > payer

...Government Accountability Office. Plans are required to report encounter data to CMS, detailing use of benefits.... ...CMS needs more data on Medicare Advantage supplemental benefits, watchdog says.... ...The GAO recommended CMS clarify its guidance about submitting supplemental benefit data and add procedural codes for services that don't yet have... ..."Having more complete information on the extent to which enrollees are using supplemental benefits, such as from the encounter data, would put CMS...

thumbnail favicon beckerspayer.com —  6+ hour, 14+ min ago

Thousands of Kaiser Permanente members in Colorado to get ...

beckerspayer.com > payer

...Thousands of Kaiser Permanente members in Colorado to get refunds after software error.... ...told the Denver Post....

thumbnail favicon beckerspayer.com —  12+ hour, 30+ min ago

BCBS Oklahoma, DRH Health reach deal

beckerspayer.com

...-based Jefferson County Hospital will remain in network with Blue TraditionalSM, Blue Choice PPOSM, Blue Preferred PPOSM, Blue Advantage PPOSM and... ...Duncan Regional Hospital will remain in network with Blue TraditionalSM, Blue Choice PPOSM and Blue Preferred PPOSM plans, according to the report...

thumbnail favicon beckerspayer.com —  13+ hour, 42+ min ago

Cigna posts $1.2B profit in fourth quarter

beckerspayer.com > payer

...Cigna posts $1.2B profit in fourth quarter.... ...Cigna beat investor expectations and reported $1.2 billion in profit for the fourth quarter, according to its year-end earnings report published... ...As of Dec. 31, Cigna had 18 million total medical members, up 5 percent year over year....

thumbnail favicon beckerspayer.com —  1+ day ago

Prior authorization and Medicare Advantage: 5 numbers to know

beckerspayer.com > payer

...Medicare Advantage plans fully or partially denied around 6 percent of prior authorization claims in 2021, according to an analysis from Kaiser Family... ...Here are 5 numbers to know about prior authorization in Medicare Advantage:. - In 2021, there were 35.2 million prior authorization requests submitted... ...Elevance Health (Anthem) plans had an average of 2.9 requests per member, while Kaiser Permanente had 0.3 requests per member. - Of the 35.2 million... ...requests submitted, 2 million were denied, around 6 percent of total requests. - Eleven percent of prior authorization denials in Medicare Advantage...

thumbnail favicon beckerspayer.com —  1+ day ago

What providers needs to know about CMS" plan to clawback $4.7B ...

beckerspayer.com > payer

...What providers needs to know about CMS" plan to clawback $4.7B in Medicare Advantage payments.... ...More scrutiny is expected for providers who serve patients covered by Medicare Advantage. 30, CMS said it will implement stricter auditing practices... ..."The level of effort for providers could easily change under this new policy," said Michael Stearns, MD, specialized consulting director of medical... ..."To "thrive" rather than simply "survive," plans need to embrace digital transformation," said Maggie Brown, regulatory compliance manager at HealthEdge...

thumbnail favicon beckerspayer.com —  1+ day ago

Payers with most MA prior authorization requests, denials

beckerspayer.com > payer

...Elevance Health has the highest number of prior authorization requests per Medicare Advantage member, while CVS and Kaiser Permanente have the highest... ...rate of denials in 2021, according to an analysis from Kaiser Family Foundation....

thumbnail favicon beckerspayer.com —  1+ day ago

CMS proposes universal quality measures across all programs

beckerspayer.com

...leaders wrote in The New England Journal of Medicine Feb.... ...CMS is looking to create a "universal foundation" of quality measures across all its programs, such as Medicare and Medicaid.... ...work with states on any reforms to Medicaid/CHIP measures.... ...CMS did not provide a timeline for launching the universal measures but said it will collect feedback on the proposal through various mediums, and...

thumbnail favicon beckerspayer.com —  1+ day ago

9 updates on prior authorization

beckerspayer.com > payer

...AHIP President and CEO Matt Eyles spoke with Becker's about how the prior authorization process can be improved.... ...As many as 42 states could introduce bills this year to limit or change prior authorization, according to Miranda Motter, AHIP's vice president of... ...Surgeon General Vivek Murthy, MD hosted a session with CMS Administrator Chiquita Brooks-LaSure and other CMS officials to discuss proposed prior... ...Boise, Idaho-based St. Luke's Health System began offering a new health plan Jan....

thumbnail favicon beckerspayer.com —  2+ day ago

Bright Health to lay off 68 employees at Minnesota headquarters

beckerspayer.com > workforce

...Bright Health to lay off 68 employees at Minnesota headquarters. Bright Health is implementing another round of layoffs, the Minneapolis/St. ... ...Paul Business Journal reported Feb.... ...Paul Business Journal, Bright Health said the end of most of its insurance offerings has "affected staffing at all levels across the organization... ...In December 2022, the New York Stock Exchange warned Bright Health it could face delistment after the company's average closing price fell below...



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