Tagged with Aetna
Aetna Clinical Payment, Coding and Policy Changes
Aetna has made adjustments to five clinical payment, coding policies that will become effective on March 1st.
Aetna Clinical Payment, Coding and Policy Updates
Aetna has released updated clinical, payment and coding policies, including multiple procedure reduction for diagnostic cardiology, diagnostic ophthalmology, and therapeutic services.
NY – 2018 Rate Increases Released
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%.
IL – Six Insurers to Take Part in Overhauled Medicaid Managed Care
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.
IL – Blue Cross Blue Shield Awaits State Review
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 Announces Plans to Shut Down Free-of-Charge Primary Care Startup
UnitedHealth Group has announced plans to shut down its subsidiary insurance startup which offered unlimited primary and behavioral care at no charge.
Aetna to Exit all ACA Insurance Marketplaces in 2018
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.
Aetna: Payment Reduction for X-Rays Using Film
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.
Justice Department Discloses False Claims Act Investigation into Multiple Payers
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 to Exit ACA Exchanges by 2018
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.
Larger Market Share = Increased Negotiating Power for Insurers
A new study reveals insurers with the largest share of local markets can negotiate lower prices for physician office visits.
Judge Denies Aetna-Humana Merger
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.
