Reimbursement

The challenge that health plans face is that within the spectrum of fraud, waste and abuse, it can be unclear if a billing mistake is accidental or intentional.

Molina Healthcare is acquiring a financially beleaguered Medicaid plan from a nonprofit insurer trying to preserve another managed care business.

Given the shift of healthcare resources to primary and preventive care, there are real, long-standing problems with the health insurance model that could be solved uniquely when the payer is owned by the provider business getting paid.

Four months until the ICD-10 deadline, and the American Medical Association is peddling the logic of waiting for the next iteration of the disease coding system, or at least delaying a bit more.

Health insurers in one large West Coast state now have to disclose claims data that for decades was proprietary, in a reluctant but heralded move towards transparency.

Health insurers need to change their silver-tier health plans to use more modest and predictable cost-sharing, instead of four-figure deductibles, according to patient advocates.

In the first update to federal MCO rules in more than a decade, the government is set to push a range of tweaks, reforms and requirements that could set a new baseline for a bustling public payer segment.

The federal government clarified that insurers can't charge people for anesthesia administered during a preventive colonoscopy to screen for colorectal cancer, although there are unresolved questions.

What's the best way to get members to stop smoking? A financial nudge and a pinch show some promise, for a range of health and wellness choices.

Aetna is plotting an acquisition seeking "inorganic growth" that could make it a rival for the largest insurer in the country, if the hype of one boutique Wall Street analyst is to be believed.