Physician Reimbursement

How to Increase Access to Prenatal Vaccines for Medicaid Beneficiaries

May 26, 2023 - Solidifying access to prenatal vaccines can help minimize maternal health disparities for pregnant people enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). A white paper from Manatt Health detailed how these programs cover prenatal vaccines and how states can facilitate access to the critical services. The Centers for...

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UnitedHealthcare Pays $91.2M After Underpaying Envision for Medical Care

by Victoria Bailey

After underpaying the medical group for essential care, UnitedHealthcare has been ordered to pay $91.2 million to Envision Healthcare (Envision). An independent three-member panel of the American...

Anthem, Valley Health Resolve Lawsuit Over Past-Due Payments

by Victoria Bailey

Regional health system Valley Health has reached a settlement agreement with Anthem Blue Cross and Blue Shield, resolving a dispute over past-due payments for healthcare claims, according to a press...

Experts Assess the Effects of the No Surprises Act on Surprise Billing

by Kelsey Waddill

The No Surprises Act may have successfully defended consumers from surprise billing but requires reworking in other areas, an issue brief from Urban Institute and the Robert Wood Johnson Foundation...

SCOTUS Sides with Group Health Plan in Dialysis Reimbursement Case

by Victoria Bailey

The Supreme Court has sided with Marietta Memorial Hospital Employee Health Benefit Plan and rejected a claim that the payer’s low dialysis reimbursement rates federal law. In 2018, DaVita, one...

CA’s In-Network Providers Increased 16% After Surprise Billing Law

by Kelsey Waddill

There are 16 percent more in-network physicians in California since the passing of the state’s surprise medical bills law — indicating that benchmark price setting may not force physicians...

Can Payers Reduce Stress of Alternative Payment Models for Physicians?

by Chuck Green

Alternative payment models (APMs) may be placing significant burdens and stress on physicians, requiring payers to make additional efforts to improve their communication and smooth the process of...

How Provider-Sponsored Health Plans Can Compete for Consumers

by Ross Erlebacher and Warren Suh

Provider organizations that take the leap to develop their own health plans compete in a highly competitive healthcare environment with established national, regional and local plans, and in some...

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