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January 12, 2017

Recent Stories

From Medicare Advantage News - Anyone with a stake in government health care is on the edge of their seats as a Republican-controlled Congress contemplates its long-awaited repeal of the Affordable Care Act (ACA) and anticipates the Jan. 20 swearing-in of the first Republican president in eight years. What at press time that means for Medicare is still anyone’s guess, complicating this year’s poll of industry experts on the issues and trends facing Medicare Advantage plans in 2017 and beyond. Read more

The repeal and replacement of the Affordable Care Act (ACA) — both… Read more

In what it says is an effort to “evaluate the integrity and… Read more

After nearly a year and a half of bouncing between the House… Read more

From the Editor

Welcome to your Medicare Advantage News subscriber-only Web page

Be sure to visit often, for PDFs of issues, archives of articles, links to government documents and more!

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January 11, 2017
Cigna Estimates It Lost 50,000 MA Members in 2016, Gained Overall

Cigna estimates it lost 50,000 MA members in 2016, but gained 300,000 to 500,000 medical customers overall. http://tinyurl.com/hxf9qr9

December 12, 2016
CMS Will Soon Monitor Timeliness of Appeals Handled by All MA/Part D Plans

As mentioned in the draft 2017 audit protocols issued in June and finalized last month, CMS is launching an industry-wide appeals timeliness monitoring project. While a Nov. 28 memo jointly issued by the Medicare Parts C and D Oversight and Enforcement Group and Medicare Drug Benefit and C&D Data Group within CMS originally stated that the agency would begin making data requests this month, a Dec. 2 transmittal clarified that it would delay its efforts to Jan. 9, 2017. Specifically, CMS will request seven Part C Organization Determinations, Appeals, and Grievances (ODAG) and 10 Part D Coverage Determinations, Appeals, and Grievances (CDAG) universes from all contracts. CMS added in the Dec. 2 memo that it is “undertaking this large scale monitoring project in response to some Sponsors' concerns that our targeted reviews that accompany program audits do not sufficiently assess all contracts.” View the original Nov. 28 memo, which contains more details, here.

November 22, 2016
New UPMC Health Plan-Reading Health System Will Feature ‘Full Spectrum’ of Products

New UPMC Health Plan-Reading Health System provider-payer joint venture will feature "full spectrum" of health insurance products. http://tinyurl.com/zbgqz7r

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