8 payer moves ASCs need to know

Here are eight updates on six of the U.S.' largest payers that ASC leaders should know:

1. UnitedHealthcare claimed it did not breach its contract with Greenville, S.C.-based Prisma Health and said the health system "coordinated a media effort to put pressure" on the insurance giant. Prisma Health alleged UnitedHealthcare breached its contract by disclosing information about Prisma Health's rate proposals to media outlets and not providing a copy of any statement to the media to Prisma 48 hours before publication. The health system requested a temporary injunction preventing UnitedHealthcare from disclosing further information. 

2. Former employees with BlueCross BlueShield of Tennessee said their religious rights were violated by the payer after they were terminated for refusing to be vaccinated against COVID-19, according to a class-action lawsuit filed in federal court.

3. Cincinnati-based Bon Secours Mercy Health sued Anthem Blue Cross Blue Shield of Virginia for $93 million, alleging the payer owes the health system for unpaid claims.

4. Humana is challenging a CMS rule that would implement stricter auditing standards on Medicare Advantage plans. In the court filing, Humana asked the judge to require CMS to vacate the final rule, as it will have "unpredictable consequences for Medicare Advantage organizations and the millions of seniors who rely on the Medicare Advantage program for their healthcare." 

5. The first wave of UnitedHealthcare's prior authorization cuts began Sept. 1. In August, the payer released details of its plan to eliminate 20 percent of its current prior authorization. The cuts are coming across two waves. The second phase will begin Nov. 1.   

6. UnitedHealthcare named Toyosi Okurounmu, MD, its national chief medical officer and vice president of medical leadership and clinical performance for its community and state division, which provides managed Medicaid services across 30 states.

7. GoodRx launched a new feature that allows providers to check a patient's insurance benefits when prescribing medications to better understand the final cost.

8. Anthem Blue Cross Blue Shield affiliates in Virginia and Connecticut are rolling out virtual-first health plans for 2024. The plans have no coinsurance costs for virtual care and offer access to an AI-driven symptom checker, virtual routine wellness care, chronic condition management and behavioral services.

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