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October 8, 2014 | Anthony Brino

In a new market for western Pennsylvania healthcare lives, Highmark and UPMC are finding old disputes lurking, adding to consumer confusion amid a new product launch and open enrollment.


October 3, 2014 | Anthony Brino

Another health system is taking a step into insurance with Medicare Advantage, banking on seniors wanting access to a prestigious brand.


September 18, 2014 | Anthony Brino

Struggling Medicare Advantage and Part D drug plans are being given a last minute reprieve, although they will need to show more improvement if they want to stay alive longer than a year.


September 10, 2014 | Anthony Brino

Health reform is creating a new impetus for regional payers and providers to collaborate on long-standing problems. Medicare is proving to be a good place to start.


August 18, 2014 | Anthony Brino

Among providers trying to get into the insurance game, some are starting off small at the local level, but in a big, growing market segment.


August 12, 2014 | Anthony Brino

Amid challenging trends in drug prices and formularies, independent pharmacy advocates are pushing for a new "any willing" provider mandate in Medicare Part D.


August 7, 2014 | Anthony Brino

Federal health officials are increasingly scrutinizing Medicare Advantage risk adjustment, suggesting policy changes and even clawbacks to come.


July 29, 2014 | Anthony Brino

Lawmakers, taxpayers and health organizations concerned about Medicare's sustainability can breathe a small sigh of relief, if not hold their breath.


July 28, 2014 | Anthony Brino

Incorporating federal sequestration into Medicare Advantage provider reimbursement has spurred a new lawsuit, and one that could spell trouble for other plans.


July 15, 2014 | Anthony Brino

Evidence from recent federal enforcement actions suggest pharmacy benefit managers are exposing public-payer managed care plans to problems that could send shivers up executive's spines.


May 29, 2014 | Anthony Brino

Medicare Advantage insurers may soon find themselves facing new public scrutiny over potential spending and overpayment discrepancies.


May 27, 2014 | Anthony Brino

The federal government and a number of hospitals may want to transition to a new Medicare reimbursement model. But there are still billions of dollars in disputed fee-for-service claims waiting to be settled.


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