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California Insurance Commission to soon give opinion on Anthem's acquisition of Cigna


The merger also needs the green light from 23 other states and ultimately the Department of Justice, which is also weighing the proposed $38.5 billion consolidation of Aetna and Humana.

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New marketplace template requires health plans to give out-of-pocket limits


Template includes coverage examples that demonstrate cost sharing amounts. Read more »

IRS could inform uninsured of coverage options and subsidies, but doesn't, report says


The Internal Revenue Service doesn't tell tax filers that their low and moderate incomes likely mean their households qualify for Medicaid or subsidies to buy coverage on the insurance exchanges. 

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Insurers required to display data on quality, cost of care for exchange plans


Exchange websites that do not call attention to the quality of medical care in a plan are more likely to see consumers selecting the low-cost alternative, according to Health Affairs.

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Consumers less likely to drop marketplace plans if they know out-of-pocket costs up front


The federal and state marketplaces would do well to nudge consumers toward health plans that result in the best fit for the individual, according to a Health Affairs report. Read more »

AHIP pleased with CMS final ruling on Medicare Advantage payment rate


The total 3.05 percent rate is less than the total 3.55 percent CMS proposed in February. Read more »

CMS threatens fines as industry struggles to maintain accurate provider directories


While healthcare provider directories have always been hard to maintain, new regulations can mean costly fines if insurers fail to keep accurate, up-to-date information on the physicians who are in their health plans. Read more »

UnitedHealth launches no-cost primary care plan to lower hospitalization rates and costs


UnitedHealthcare is betting $65 million that it can profit by making primary care more attractive. Read more »

Medi-Cal extends benefits to all low-income children regardless of immigration status


Once the transition to full Medi-Cal occurs, beneficiaries will have 60 days to choose a managed care health plan for children already enrolled in restricted-scope Medi-Cal.

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Insurers, providers could save $8 billion by automating HIPAA transactions, CAQH Index says


The healthcare system in the United States is spending billions per year unnecessarily by continuing to use manual administrative processes, according to the 2015 CAQH Index that measures the shift to electronic HIPAA transactions between health plans and healthcare providers.

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Healthcare industry tops list for data breaches in response plan report


The rate of security incident disclosures in 2015 surpassed those of 2014, according to the second annual BakerHostetler Security Incident Response report. What's more, healthcare tops the list for frequency of data breaches. Read more »

CMS rule requires payment parity for mental health, substance abuse services


The Centers for Medicare and Medicaid Services is aligning mental health and addiction payment requirements already in place for private health plans to states providing these services to low-income adults and children.

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President's task force to enforce insurer parity in mental health payments


The interagency task force, which will be chaired by the White House's Domestic Policy Council, will aim to identify and promote best practices for state and federal agencies to ensure that insurers are complying with the parity law.

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EmblemHealth, Northwell partner in health plan/provider shared-risk agreement


EmblemHealth and Northwell Health in New York have agreed to share risk in value-based contracts, EmblemHealth announced March 25. Read more »

Payer mix among major challenges for Massachusetts community hospitals, study finds


The payer mix in a hospital system exerts enormous influence over its financial success and stability, or lack thereof, said the commission. For community hospitals, a large share of their patients are covered by government payers, and that means lower rates than for commercial patients.

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When insurers drop Medicare Advantage providers, consumers switch plans


After insurers dropped hundreds of providers in 2013, the Centers for Medicare and Medicaid Services issued rules giving people a "special enrollment period" to change plans or join regular Medicare if there was a "significant" change in their provider network.

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AHIP tests 'one stop' provider directory model as fines threaten insurer inaccuracies


For the program to work, it requires cooperation between providers and health plans, according to AHIP President and CEO Marilyn Tavenner.

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Getting to clean claims: Costs start to add up for payers, providers on the first error


Errors in insurance claims are costing the healthcare industry billions in wasteful spending, and both the payers and the providers are at fault, experts say.

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Maine Community Health Options, the only profitable co-op in 2014, posts major losses


The Maine Bureau of Insurance is closely monitoring Community Health Options, as the nation's only profitable co-op under the Affordable Care Act in 2014 posted a net loss of $74 million for 2015 and 2016 this month, according to information on the maine.gov website. Read more »

New Aetna/Virtua ACO to offer co-branded commercial health plan in New Jersey


The Aetna Whole Health-Virtua plan will be introduced in South Jersey later this year and will use Virtua's community-based health system of hospitals, outpatient facilities, urgent care centers, and health and wellness centers. Read more »

Insurers lose big on long-term care policies


Hemorrhaging money, many insurers left the long-term care business. Those that remain are in financial trouble on their policies. They're charging far more for new policies, and sharply raising the premiums of old ones.

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Insurers invest in mindfulness as wellness market grows


Insurers are investing in programs that have moved beyond tobacco-free living sessions and gym membership benefits.

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Insurers, providers fight California's insurance exchange threat to cut poor-performing hospitals


Insurers, which have long resisted efforts to let competitors or the public see the deals they make with doctors and hospitals, have aligned with providers against a plan by California's insurance exchange to cut hospitals from its networks for poor performance or high costs.

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Vermont cannot force Liberty Mutual to release claims data, Supreme Court rules


The Supreme Court has sided with Liberty Mutual Insurance and against the state of Vermont in a decision that could have implications for insurers nationwide.

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Medicare Advantage holds out against Part D coinsurance drug plans


The percentage of drugs requiring coinsurance has climbed steadily, increasing from 35 percent in 2014 to 45 percent last year. That percentage is approaching two-thirds of all covered drugs.

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