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.
Another health system is taking a step into insurance with Medicare Advantage, banking on seniors wanting access to a prestigious brand.
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.
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.
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.
Amid challenging trends in drug prices and formularies, independent pharmacy advocates are pushing for a new "any willing" provider mandate in Medicare Part D.
Federal health officials are increasingly scrutinizing Medicare Advantage risk adjustment, suggesting policy changes and even clawbacks to come.
Lawmakers, taxpayers and health organizations concerned about Medicare's sustainability can breathe a small sigh of relief, if not hold their breath.
Incorporating federal sequestration into Medicare Advantage provider reimbursement has spurred a new lawsuit, and one that could spell trouble for other plans.
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.
Medicare Advantage insurers may soon find themselves facing new public scrutiny over potential spending and overpayment discrepancies.
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.
Humana nurtures new Medicare Advantage ACO
Hospital CFO to face jail time for fraud
Florida Blue beckons members to telehealth kiosk
Dominant Blue fights a flaw in state transparency law
HHS moves against skinny group plans
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