Tagged with Aetna
Effective July 1, Aetna will update its pharmacy plan drug lists. These changes will affect all Pharmacy Management drug lists, precertification, quantity limits and step-therapy programs.
Effective July 1, Aetna will implement changes to its clinical payment and coding policies as well as several changes to its National Precertification List (NPL).
Aetna has issued a notice reminding providers and billing professionals that Medicare beneficiaries under the Qualified Medicare Beneficiary (QMB) program should not be billed for cost sharing (balanced billing).
Aetna has made adjustments to five clinical payment, coding policies that will become effective on March 1st.
Aetna has released updated clinical, payment and coding policies, including multiple procedure reduction for diagnostic cardiology, diagnostic ophthalmology, and therapeutic services.
The New York Department of Financial Services has released 2018 health insurance rates for the state’s individual and small group markets, including rates for the NY State of Health, New York’s official health plan marketplace – ranging from 4.4% for Excellus to 31.5%.
The Illinois Department of Healthcare and Family Services has announced the names of the insurers that will take part in the Governor’s proposed overhaul of the state’s Medicaid Managed Care program.
For the first time since 1990, the Illinois Department of Insurance will conduct a broad market examination of Blue Cross and Blue Shield of Illinois to see how the insurer treats its customers in compliance with consumer protection regulations.
UnitedHealth Group has announced plans to shut down its subsidiary insurance startup which offered unlimited primary and behavioral care at no charge.
Aetna has announced plans completely withdraw from the ACA insurance exchanges for 2018, citing financial losses as the deciding factor, specifically its individual commercial products lost nearly $700 million between 2014 and 2016 and could lose another $200 million this year.
Applicable to the technical component, claims billed with modifier FX to indicate X-ray imaging services were provided using film reduces will be subject to a 20% reduction.
Two separate studies investigated why consumers respond to high-deductible plans by using less healthcare services, which in turn leads to a decrease in doctor visits and clinical laboratory test orders.
The U.S. Justice Department recently disclosed that there will be an investigation into four more major health insurers as part of a False Claims Act lawsuit filed against UnitedHealth Group in 2011.
Humana has announced its plans to cease sales of individual health insurance plans through the ACA’s exchanges by 2018, potentially leaving more than 150,000 customers without a carrier.
A new study reveals insurers with the largest share of local markets can negotiate lower prices for physician office visits.
A federal judge ruled against Aetna’s proposed acquisition of Humana, maintaining the Justice Department’s decision that the multi-billion deal would be anticompetitive and raise prices for consumers.
The only northeastern state not to choose Medicaid expansion under the Affordable Care Act (ACA), Maine will be one of five of the original 23 ACA-created co-ops that will continue into 2017. In response and in hopes of in hopes of extending coverage to 70,000 residents, residents are petitioning to put a proposal to expand the ME Medicaid program before the Legislature.
A new report from Healthcare Financial Management Association (HFMA) suggests that value-based care and price transparency will add value to hospital mergers, including lower prices for consumers.
Aetna will soon offer two Medicare Advantage Part D/Prescription Drug (MAPD) plans in three counties in Central Florida.
Highmark confirms it will not sell plans to residents of York, PA on the federal health insurance marketplace on the 2017 Pennsylvania health insurance exchange.