Health Plan Business

From The AIS Report on Blue Cross and Blue Shield Plans - Blues plan operator HealthNow New York, Inc. will pay a $60,000 civil penalty and $1.6 million in wrongfully denied claims to patients who sought outpatient psychotherapy and nutritional counseling related to eating disorders, New York Attorney General (AG) Eric Schneiderman said Aug. 22. The Buffalo-based company, which operates BlueCross BlueShield of Western New York and BlueCross BlueShield of Northeastern New York, has about 578,000 members. Read more

From Health Plan Week - New research makes a case for including emergency department (ED) services in alternative payment models (APMs) that are being promoted by HHS as part of the movement away from traditional fee-for-service (FFS) reimbursement. But according to one of the authors of the report, the ED segment is not an easy one to include in accountable care, bundled payment or capitation systems due to its unique role in the care continuum. Read more

Health Plan Business Blog

By Patrick Connole - June 6, 2016
If you were in charge of a U.S. health insurer, what issue would make you lose sleep as you peer ahead to the rest of 2016 and into next year? When a pair of consultants and a noted lawyer were asked that question, they produced a list of challenges for health insurers that amounted to a virtual...
By Patrick Connole - May 31, 2016
When the Missouri insurance regulator came out on May 24 with a preliminary finding declaring its opposition to the pending Aetna Inc. acquisition of Humana Inc., industry watchers and stakeholders immediately took to form and either said (1) this spells doom for the deal’s overall approval, or (2...
By Steve Davis - April 28, 2016
CMS is considering several tweaks to its risk-adjustment program established by the Affordable Care Act (ACA) including a high-risk pool, partial-year enrollments and the inclusion of prescription drug claims as predictors of diagnoses or severity of illness. On April 11, I moderated a well-...

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