News

The drug formularies of some small group health plans in two states don't meet essential health benefit benchmarks, a new study has found, leaving researchers pointing to a solution that may be as complex as benefit mandates.

Hospitals and healthcare centers are in strong competition for skilled physicians and nurses. That puts added pressure on the credentialing process. Fortunately, the process has been made easier thanks to electronic access to data.

Federal healthcare auditors think Medicaid managed care organizations aren't doing enough to combat fraud and that states might have to step in with policy changes.

As Oregon transforms how it delivers care to 780,000 Medicaid patients, it hopes to generate better outcomes at lower costs. The problem for Oregon hospitals is that these goals conflict with the traditional aim of boosting revenue through ER visits and inpatient stays.

Now that health plans are required to be compliant with the newly adopted operating rules for electronic funds transfers and electronic remittance advice, electronic transactions might be poised to overtake healthcare.

Through the beginning of March, 4.2 million Americans signed up for private coverage through state and federally-run exchanges, leaving federal health officials hoping for a final month's surge to meet initial projections, especially for millennials.

Aetna is going forward with an accountable care agreement for some 28,000 people, partnering with a health system that also has accountable care contracts with some competitors.

WellPoint's Amerigroup is the first Medicaid plan in the nation to use a health record chip that enthusiasts are calling a "breakthrough health IT solution."

With several states weighing whether to expand Medicaid under the federal health law, supporters are looking to powerful business groups to help sway skeptical state legislators. But those groups are split on the issue -- just like the public at large.

The National Committee for Quality Assurance wants to modernize its health plan accreditation program with a range of new requirements that in some cases mirror trends in regulatory scrutiny.