The UNC Health and Cigna contract lapse leaves tens of thousands out-of-network, highlighting ongoing challenges in hospital-insurer negotiations and payer-provider relationships in North Carolina.
CMS reinstates bonus payments for Medicare Advantage plans and proposes removing administrative star rating measures, impacting key insurers like Humana and UnitedHealth Group.
Legal investigation examines CVS/Aetna's use of AI in denying prior authorizations for post-acute care under Medicare Advantage plans, highlighting regulatory and compliance challenges in insurance claims processing.
Medicare delays $7.8B hospital drug cost clawback, appeals MA audit ruling, and adds cardiac ablations to ambulatory surgery coverage for 2026.
The unresolved contract dispute between UNC Health and Cigna risks out-of-network status for thousands of patients, reflecting broader insurer-provider negotiation challenges in North Carolina's healthcare market.
Rising cost pressures and demographic shifts fuel intensified disputes between payers and providers over Medicare Advantage contracts, impacting reimbursement and network participation.
Starting in 2026, MultiCare will no longer accept certain Medicare Advantage PPO plans, impacting access for some seniors. The shift focuses on HMO plans for better care coordination during Medicare open enrollment.
Geisinger Health Plan earns 2026 Best Insurance Company for Medicare Advantage in Pennsylvania, recognized for high-quality coverage and member services based on CMS quality measures.
CMS proposes to revamp Medicare Advantage Star Ratings, affecting insurer compliance and operations. Legal appeals and health system updates also impact the US market.
KFF research reveals widespread use of chart reviews in Medicare Advantage, increasing diagnoses and boosting CMS payments with AI-driven risk adjustment implications.
