Tag:

Provider Networks

Latest Headlines

Latest Headlines

3 key reasons CMS overhauled MCO rule

Although insurers have already begun pushing back against proposed Medicaid managed care organization regulations, the Centers for Medicare & Medicaid Services released the rule so that it could catch existing regulation up with reality.

Use of tiered networks prompts hospitals to cut prices

Hospitals now operate in a world of increasingly narrow provider networks and tiered preferences. How do those elements impact their bottom line? They take a fairly significant bite, according to a recent study conducted by Harvard University on behalf of the Commonwealth Fund.

CMS tightens provider directory rules for 2016

Starting next year, health insurers must provide up-to-date doctor lists for their  Medicare Advantage and Healthcare.gov policies, according to the Centers for Medicare & Medicaid Services.

Medicare Advantage plans could lose members to feds

If Medicare Advantage plans drop significant amount of providers from their networks, their affected members can leave those plans and enroll instead in traditional Medicare.

OIG: Insurers' Medicaid provider directories are inaccurate

Medicaid insurers' provider directories include doctors who are unavailable, not accepting new patients or could not be found, says a report from the Office of the Inspector General.       

Company aims to help uninsured without actually insuring them

Health insurers have lots of competition vying for the same consumers, especially in the health insurance exchanges, but one non-traditional company could be looking to compete against traditional insurers in a whole new way.

Insurers: Clean up your provider networks

I have a friend, let's call her Amy, who casually told me last week how she struggled to find a pediatrician for her children since moving to our town. She said all the doctors she had called either weren't accepting new patients or "don't take Affordable Care Act plans."

Study: Medicare Advantage networks include many docs that aren't available

Medicare Advantage insurers "substantially overestimate" how many in-network dermatologists can treat patients in several different markets. Many of the doctors weren't actually available--including some that are dead, retired or not accepting new patients, according to a new study published in the Journal of the American Medical Association Dermatology.

Do state officials have authority over Medicare Advantage insurers?

As Pennsylvania officials have attempted to force Highmark into expanding its Medicare Advantage network, Highmark pushed back by claiming that the state lacks authority over the federal program.

Feds release guidance on reference pricing, network adequacy in ACA group plans

The U.S. Departments of Labor, Treasury and Health and Human Services released a frequently-asked question document offering guidance on the use of reference pricing in non-grandfathered large group employer plans. This may be the first time the departments have tried to regulate group health plan network requirements under the Affordable Care Act according to a  Health Affairs  blog post by attorney Timothy Jost.