Payers & Policy
CMS Proposes Rule To Improve Medicare Advantage Provider Directories
The proposed changes would implement key healthcare provisions in a government funding package from February. The brunt of the reforms would go into effect in 2028.
Section
Payers & Policy
8 stories from the past week in Payers & Policy, from Diagnosis Forward.
3 tips to manage soaring health costs
Speaking at the CFO Leadership Council’s fall conference in Colorado, Marsh McLennan Senior VP Marybeth Gray shared ideas to keep employees healthy and costs down.
Trump administration boots 189K deceased, duplicate enrollees off ACA subsidies
It comes amid a broader crackdown on the ACA exchanges as the Trump administration continues its efforts to identify “fraud, waste and abuse” in federal programs.
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.
Thoreau-backed Ensemble, Penelope Health partner to bring payer policy intelligence into RCM
Two Thoreau-backed healthcare companies are partnering to bring real-time payer policy intelligence into revenue cycle workflows. The aim is to move claims denial management upstream into denial prevention, the companies said.
Alignment sues CMS over 2027 Medicare Advantage star ratings crash
The lawsuit isn’t a surprise, after Alignment told investors it would take all available actions to improve its quality scores.
UnitedHealth eyes Medicare Advantage opportunities, bolstered by Q3 profit growth
UnitedHealth raised its 2026 earnings guidance and outperformed analyst expectations for the third time this year, suggesting its financial turnaround is sustainable.
Alignment Healthcare sues CMS over its 2027 Medicare Advantage star ratings
Alignment Healthcare sued federal regulators, alleging that its 2027 Medicare Advantage star ratings were determined "in flagrant violation" of statute.