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7 traits to seek in a validation audit vendor


As dry as the decision may appear, insurers literally have millions of dollars on the line when CMS comes knocking. That makes picking the right auditor, and doing so the first time, absolutely critical. Read more »

Ignagni departing AHIP, with industry in ACA transition


The chief lobbyist for American health insurance is taking a job at a regional nonprofit insurer, after shaping a once-in-a-generation reform aimed at benefiting both the public and the industry. Read more »

CareFirst attack breaches data on 1.1 million


It was only a matter of time until a big regional Blue Cross insurer got hacked, except that time was a year ago and security experts just recently uncovered it. Read more »

A penalty for covering abortions, missing autism benefits


Aetna has found itself in the odd position of being fined for covering something some members wanted, while not being fully up to speed covering another condition. Read more »

Insurers line up for CMS oncology pilot


The trajectory of cancer care is so costly and problematic that insurers are flocking in droves to the federal government’s multi-payer alignment experiment. Read more »

Double digits: Some individual plans seek steep rate hikes


With little more than a year of claims experience on the new individual market, some insurers are looking for premium increases of more 30 percent, including the Blues. Though affordability is still relative. Read more »

Selling a Medicaid plan to save Medicare Advantage


Molina Healthcare is acquiring a financially beleaguered Medicaid plan from a nonprofit insurer trying to preserve another managed care business. Read more »

ICD-When? AMA wants to wait for 11


Four months until the ICD-10 deadline, and the American Medical Association is peddling the logic of waiting for the next iteration of the disease coding system, or at least delaying a bit more. Read more »

Mandate brings another all-payer database to market


Health insurers in one large West Coast state now have to disclose claims data that for decades was proprietary, in a reluctant but heralded move towards transparency. Read more »

Redesign silver plans with lower deductibles, consumer group urges


Health insurers need to change their silver-tier health plans to use more modest and predictable cost-sharing, instead of four-figure deductibles, according to patient advocates. Read more »

Here come new Medicaid MCO regulations: 5 issues to watch


In the first update to federal MCO rules in more than a decade, the government is set to push a range of tweaks, reforms and requirements that could set a new baseline for a bustling public payer segment. Read more »

Feds: No cost-sharing for anesthesia in colonoscopies


The federal government clarified that insurers can’t charge people for anesthesia administered during a preventive colonoscopy to screen for colorectal cancer, although there are unresolved questions. Read more »

Optimizing the 'nudge' for interventions


What’s the best way to get members to stop smoking? A financial nudge and a pinch show some promise, for a range of health and wellness choices. Read more »

Big and bigger: What's the next insurer takeover?


Aetna is plotting an acquisition seeking "inorganic growth" that could make it a rival for the largest insurer in the country, if the hype of one boutique Wall Street analyst is to be believed. Read more »

L.A. Care hikes minimum wage to $15


On the West Coast, the nation's largest municipal-operated health plan is trying to mesh its compensation structure with its nonprofit mission. Read more »

PBM giant finds surge in patients with six figure drug spending


$52 billion and growing is the trend in high-cost pharmacy benefits, as more and more Americans use prescription drugs with expenses exceeding the U.S. median household income. Read more »

Radical approach to huge hospital bills: Set your own price


In the late 1990s you could have taken what hospitals charged for inpatient chemotherapy and bought a Ford Escort econobox. Today average chemo charges are enough to pay for a Lexus GX SUV, not even counting the price of anti-cancer drugs. Read more »

More state exchanges on verge of implosion


If nothing else, the collapse of multi-million dollar state-based exchanges has created a PR problem for health reform, but that’s only part of the issue. Read more »

Sitting out HIX again, Wellmark still paying for ACA


For the third year, Iowa's largest insurer is shunning the state exchange, letting for-profit competitors take on subsidized members. Read more »

IRS heeds call to probe Blues MCR questions


From the depths of the Internal Revenue Services comes an attempt to clarify some ambiguities for the uniquely taxed Blue Cross Blue Shield insurers and their medical cost ratios. Read more »

'Free' contraception means free


When it comes to comprehensive contraception options as a preventive health benefit, free means free, regulators reminded the insurance industry. Read more »

Meant to reduce risk, corridors may bring instability


Based on insurer estimates of payables and receivables, plus an uncertain funding limit, the risk corridor program can seem like it's actually making the new individual market more shaky. Read more »

Horse-and-buggy billing awaits digitization, simplification


While so much is changing, so much is still the same in healthcare, like the fact that some 85 percent of commercial health insurance payments are still paper-based. Read more »

Diabetes spending soars in employer-sponsored plans


The increasing prevalence of diabetes is, as it happens, coming with rising costs, especially for kids. Read more »

Florida Governor leaves D.C. empty-handed


Florida Gov. Rick Scott's high-stakes visit to Washington to persuade the Obama administration to keep the federal government's $1 billion in annual funding for hospital care of the poor produced no breakthrough. Read more »

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