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MedGate for Health Insurers: A Proven Way to Reduce Costs, Prevent Complications & Improve Outcomes

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Anthem may penalize hospitals 10% for using out-of-network providers - Becker's Payer Issues | Payer News Elevance Health has shared plans to potentially penalize hospitals and other contracted facilities that use care providers who are not in-network with its Anthem Blue Cross Blue Shield commercial…

Facilities could face an administrative penalty for using #OutOfNetwork providers. They would not be able to bill members to cover this penalty, and they could also be terminated from #Anthem’s network. #NoSurprises #RAPL #hospitals #ElevanceHealth

Elevance posts $1.2B profit in Q3 - Becker's Payer Issues | Payer News Elevance Health posted a net income of about $1.2 billion during the third quarter, up 17.8% from roughly $1 billion at the same time last year, according to an Oct. 21 earnings statement. “Our…

The parent company of #Anthem, #Wellpoint, and #Carelon (among others) posted revenues of $50.7bn and expenses of $49.3bn, for a net income of $1.2bn (~2.5% profit margin) during the third quarter. #ElevanceHealth #HealthCoverage

Elevance Health loses bid to challenge US Medicare star ratings By Diana Novak Jones CHICAGO (Reuters) -A federal judge in Texas on Tuesday rejected Elevance Health’s challenge of the U.S. government’s calculation for the health insurer’s star ratings for some of its government-backed Medicare plans after the company said improper rounding cost it at least $375 million. U.S. District Judge Mark Pittman in Fort Worth, Texas, sided with the U.S. Department of Health and Human Services after the company sued to fight the star rating assigned to one of its contracts, arguing the agency’s calculations for the ratings were flawed. Pittman said Elevance had not pointed out any major problems with the calculations and that the process is too complicated for the court to evaluate it beyond that. Elevance, the parent of companies including Anthem Blue Cross and Blue Shield and Carelon, provides Medicare Advantage plans in the U.S. The plans are funded by the Medicare health insurance program for seniors and some disabled people, but administered by private insurers. The U.S. Centers for Medicare & Medicaid Services, which is part of HHS, issues star ratings for the plans, from one to five stars, to help beneficiaries choose among them. Plans with higher star ratings receive higher payments from the government if they keep costs below certain targets. Those bonus payments can be worth hundreds of millions or billions of dollars. Elevance had said the agency’s calculations for 2025 caused at least one of its contracts to just miss being rated at the next higher tier, likely costing the company at least $375 million in bonus and other payments. A spokesperson for Elevance did not immediately respond to a request for comment. Neither did representatives for HHS. Elevance filed its lawsuit in October, after one of its contracts received a score of 3.749565 and was assigned 3.5 stars. The company said CMS had not followed its own regulations when it rounded down, and the contract should have been rounded up to 4 stars. HHS countered that its scoring process was sound, arguing that if the court allowed Elevance’s challenge to move forward, it would be opening the door to yearly challenges from insurers whose contracts just missed the cutoff for higher tiers. Last month, another Texas federal judge tossed a lawsuit brought by Humana (NYSE:HUM) that challenged the reduction in the health insurer’s star ratings after finding that Humana had failed to exhaust all of its out-of-court options to challenge the ratings.

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Top Stock Movers Now: PepsiCo, Elevance Health, CSX, and More - Investopedia Top Stock Movers Now: PepsiCo, Elevance Health, CSX, and More  Investopedia

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Elevance Health, Inc. (ELV): Among the Cheap ESG Stocks to Buy According to Hedge Funds - Yahoo Finance Elevance Health, Inc. (ELV): Among the Cheap ESG Stocks to Buy According to Hedge Funds  Yahoo Finance

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Stocks from the Biggest Health Insurance Carriers Fall After CEO's Death

Shares of UnitedHealth Group, Cigna Group, and Elevance have all dropped in the past week as America reacts to the assassination of Brian Thompson...

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