Blue Cross Blue Shield of Massachusetts is expanding its claims review process to address what it is describing as potential overcoding among physicians who routinely bill for high-complexity visits.

CMS Administrator Mehmet Oz, MD, told FOX 5 Atlanta that the government shutdown is not affecting Medicare open enrollment. “The shutdown is a problem for lots of parts of government but not for ...

Elevance Health is deepening its use of artificial intelligence enterprise-wide, focusing on enhancements to its member services, clinical workflows and provider operations as part of long-term ...

Johnson City, Tenn.-based Ballad Health is suing UnitedHealth Group for alleged “Medicare Advantage manipulation” that has led to denied care and underpayment for services. The lawsuit was filed Oct.

Elevance Health has shared plans to potentially penalize hospitals and other contracted facilities that use care providers who are not in-network with its Anthem Blue Cross Blue Shield commercial ...

Elevance Health is working to mitigate rising costs in its Medicaid business amid what executives describe as a challenging year ahead. The company reported its third-quarter earnings on Oct. 21, with ...

Oklahoma Attorney General Gentner Drummond challenged the state’s managed care Medicaid in an Oct. 22 letter to the Oklahoma Health Care Authority, the agency that oversees the program. Mr. Drummond ...

The high cost of GLP-1 drugs have thrown a curveball at payer strategy. Employers providing health insurance are also grappling with the fallout. From January to July, Davis Research interviewed ...

Molina Healthcare reported a 72% decline in net income for the third quarter and has reduced its adjusted annual earnings guidance for the third time this year to $14 a share as the company faces ...

Coverage for drugs recently approved by the FDA can take months to solidify, according to the Institute for Clinical and Economic Review’s “Launch Price and Access Report,” published Oct. 23.

UnitedHealth’s Optum has launched Optum Real, a real-time claims system designed to streamline the claims and reimbursement process by providing instant coverage validation for providers. “Optum Real ...

Emerging technologies like generative AI and predictive analytics will be a difference maker in terms of health plans operating more efficiently in the very near future. Becker’s connected with ten ...