2016 Medicare Parts C & D Audit & Enforcement Findings

Posted by & filed under Uncategorized.

Last Tuesday, the Centers for Medicare and Medicaid Services (CMS) released their 2016 Medicare Part C and Part D Program Audit and Enforcement Report. This report summarizes the audit findings on carriers’ Compliance Program Effectiveness (CPE), Part D Formulary and Benefit Administration (FA), Part D Coverage Determinations, Appeals, and Grievances (CDAG), Part C Organization…

2016 Medicare Parts C & D Audit & Enforcement Findings

Posted by & filed under CMS, Medicare.

Last Tuesday, the Centers for Medicare and Medicaid Services (CMS) released their 2016 Medicare Parts C and Part D Program Audit and Enforcement Report. This report summarizes the audit findings on carriers’ Compliance Program Effectiveness (CPE), Part D Formulary and Benefit Administration (FA), Part D Coverage Determinations, Appeals, and Grievances (CDAG), Part C Organization…

Anthem-Cigna Merger Trial Currently Underway

Posted by & filed under Anthem, Cigna, News.

It’s been 17 months since Anthem announced it would buy Cigna for $48.4 billion. With the recent start of the Anthem-Cigna merger trial, we’ll all soon know if they can legally seal the deal. Throughout the two-part hearing, the U.S. Department of Justice, Anthem, and Cigna will argue over the merger’s effect on the…

BCBS of Nebraska Leaving ACA Marketplace

Posted by & filed under Affordable Care Act, Blue Cross and Blue Shield of Nebraska, Nebraska, Uncategorized, Under 65.

Not so long ago, Nebraskans had three carriers they could choose an individual health plan from on the state’s Affordable Care Act exchange. Now, they have two as a result of Blue Cross and Blue Shield of Nebraska (BCBS of Nebraska) exiting the state’s ACA marketplace. With only a few weeks to go before the…

PA MLTSS Contracts Awarded to AmeriHealth Caritas, Centene, & UPMC

Posted by & filed under AmeriHealth Caritas, Centene Corporation, Pennsylvania, UPMC.

Pennsylvania’s Department of Human Services has granted AmeriHealth Caritas, Centene Corp., and UPMC contracts for its new Medicaid program. Community HealthChoices, Pennsylvania’s first-ever program for providing managed long-term services and supports (MLTSS), is scheduled to go live July 1, 2017, in the state’s southwestern region. It will continue to be implemented in zone-based…