Search
Margin improvement, MA member retention doable, as is top quartile star rating results in 2028, company says.
CEOs of four health systems testified before the House Ways and Means Committee Tuesday morning.
The approach will be used for medical services that are commonly subject to prior authorization, such as orthopedic surgeries and imaging services.
The pathway will allow the evidence generated for FDA review to support Medicare coverage decisions.
Cost control, Carelon integration and scaling AI are reasons for the company's confidence.
Fifty percent of the payment will be withheld to be reconciled after a 12-month care process, subject to two downward adjustments.
HHS is proposing to adopt certain HL7 FHIR standards and implement specifications for transactions related to prior authorizations.
The proposed rule would also make the Comprehensive Care for Joint Replacement (CJR) Model mandatory beginning on Oct. 1, 2027.
Nineteen states and D.C. are seeking to invalidate a March 2025 directive to reduce the number of HHS employees and eliminate several sub-agencies.
Aetna's policy results in denials and underpayment and violates CMS' Two Midnight Rule, the health system says.
