Elevance Health is changing how it evaluates and pays certain hospital claims, putting greater scrutiny on where care is delivered as the insurer moves to address higher hospital rates for services provided at off-campus locations.
A common practice for Medicare, Elevance Health said it was the first commercial market payer to...
Elevance Health is following the lead of other Medicare Advantage insurers by filing suit against the Centers for Medicare and Medicaid Services (CMS), alleging that they refused to allow the same star ratings boost given to Clover Health after a recent court ruling. Plaintiffs include Elevance's Medicare Advantage (MA) plan affiliate...
The lawsuit names Aetna, Cigna, UnitedHealthcare, Humana, Elevance Health, Molina Healthcare, Centene and Health Care Service Corp. as defendants. The Arizona case adds to a growing body of litigation surrounding MultiPlan's out-of-network reimbursement practices.
According to Arizona's complaint, insurers allegedly shared...
The Centers for Medicare & Medicaid Services (CMS) on Monday finalized a stronger-than-expected payment update for Medicare Advantage (MA) plans in 2027, backing off from an earlier proposal from the agency that signaled flat funding, which triggered industry concern over benefit cuts and market exits.
CMS said the final rate...
Wall Street thrashed Elevance Health's stock after it cut its profit guidance for the year due to increased healthcare use and issues with government payers. Financial expectations for the healthcare market are low and continue to fall.
Elevance executives attempted to delicately break the news that it would need to adjust...National News
Elevance Health executives tried to calm investor fears around Medicare Advantage in its first quarter (Q1) returns call last week, but the company took drastic action to end its involvement in the program shortly after the call.
Chief Financial Officer Mark Kaye said on the company call that while costs of care were higher than...
Earlier this year, two judges ruled that the Centers for Medicare and Medicaid Services (CMS) had improperly calculated Medicare Advantage scores and subsequent bonuses under the Star Ratings program last October. This week, CMS issued revised quality ratings for 2024, with a number of plans receiving far higher ratings and bonuses than...
The Centers for Medicare and Medicaid Services (CMS) have decided to recalculate the 2024 Medicare Advantage (MA) star ratings and allow plans to resubmit bids for 2025 if their scores increase. Insurers are thrilled.
Two federal courts recently determined that CMS improperly calculated MA star ratings for 2024 after applying a...National News
Last week SCAN won its case against the Department of Health and Human Services after claiming the Centers for Medicare and Medicaid Services (CMS) improperly calculated its 2023 MA star ratings, the insurer will now receive a $250 million quality bonus. Shortly after the decision, the same federal court ruled CMS must recalculate BCBS...National News
Medicare Advantage (MA) plans in collaboration with the Centers for Medicare and Medicaid Services (CMS) offers comprehensive healthcare services covered by Traditional Medicare (TM) with many now providing robust supplemental benefits. MA continues to grow rapidly and covers half of all eligible Medicare members from diverse...Arizona News
This week in Medicare Advantage news, prior authorization reform garners the support of the Better Medicare Alliance, Puerto Rico offers insight into the future of the MA program, a CMS rule on third-party marketing goes into effect and we share some acquisition news.
Last week, the Better Medicare Alliance, the largest lobby for...
