Revenue Cycle and Payer News – November 9, 2022

Collaboration News

Cohere Health and Humana Expand Partnership to Further Improve Physician and Member Experiences
Cohere Health (@CohereHealth), a company in intelligent utilization management (UM) technology, announced that Humana Inc. will expand its use of Cohere’s digital UM collaboration platform to enable seamless prior authorization for cardiovascular and surgical services.

Easterseals Announces National Partnership with Nonprofit Health Insurer CareSource
Easterseals announced that it has received a donation of $2.55 million from CareSource (@caresource), a nationally recognized leader in managed care with a legacy of providing quality health care coverage for Medicaid consumers.

Humana, USAA Launch New Medicare Advantage Plan Tailored to Veterans’ Needs
Humana Inc. (@Humana) and USAA Life Insurance Company announced a new Medicare Advantage plan designed with veterans in mind to provide a robust coverage option that complements healthcare benefits received through Veterans Affairs (VA).

Company News

Lumeris Announces Seven New Health System Partnerships as Five Star Essence Health Plan Expands into Five New States
Lumeris (@lumeris), a provider of the technology, insurance capabilities and expertise to support value-based care models, announced the 2023 market expansion of Essence Healthcare, the company’s wholly owned Medicare Advantage (MA) plan, into five new states and 44 new counties.

UnitedHealthcare Expands Its Individual and Family Plan Footprint in the Health Insurance Marketplace – Offering Affordable Benefits in 22 States for 2023
UnitedHealthcare (@uhc) announced its 2023 Individual and Family Plans in the Health Insurance Marketplace, which will feature affordable coverage, a wide range of benefits, and a simple service experience in 22 states.

Independence Blue Cross offers a wide range of comprehensive choices, zero-dollar virtual care for individual consumers
For individuals and families looking for health care coverage in 2023, Independence Blue Cross (@ibx) will continue to offer a variety of health plans with comprehensive health care coverage and access to quality care. Individuals have from November 1, 2022, to January 15, 2023, to enroll in a health plan if they want coverage for 2023. Consumers who want to be covered starting January 1, 2023, must enroll by December 15, 2022.

CVS Health reaches agreement in principle for global opioid settlement
CVS Health® (@cvshealth) announced that it has agreed in principle to a financial resolution designed to substantially resolve all opioid lawsuits and claims against the company by states, political subdivisions, such as counties and cities, and tribes in the United States.

Product News

Cedar’s Integrated Payer-Provider Patient Billing Platform Introduced to Highmark Inc. and Allegheny Health Network Customers
To address the systemic challenges consumers face when paying for healthcare, Cedar (@CedarNY), an enterprise healthcare engagement platform that improves the end-to-end consumer financial journey, has developed the Payer Intelligence Layer.

Independence Blue Cross announces 2023 health plan options for large employers
Independence Blue Cross (Independence) announces its 2023 medical and prescription drug plan options for employers headquartered in southeastern Pennsylvania with 51 or more employees. This product portfolio is available upon renewal for insured and self-funded groups starting January 1, 2023.

Medicare Advantage Programs Help Ease the Struggles of Rising Food Costs for Seniors
With food prices increasing at an annual rate of 13.5 percent, according to the Consumer Price Index, a rate not seen for more than 43 years, some seniors are finding ways to save on how much they spend on healthy food with special programs available through Medicare Advantage health plans. Medica’s (@Medica4Me) Healthy Savings benefit gives qualified members the opportunity to save up to 50 percent on fresh fruits and vegetables, up to $65 each quarter. About 83 percent of Medica’s Medicare Advantage members qualify for the program.

To Read

How to navigate this year’s Affordable Care Act enrollment By PBS News Hour – Currently, more than 14.5 million people get their health insurance through the ACA, commonly known as “Obamacare.” The number swelled during the coronavirus pandemic after Congress passed generous subsidies to make coverage more affordable.

6 health insurance terms you need to know as open enrollment begins by CNBC – It’s open enrollment season, the time each year when millions of American workers and retirees must choose a health plan, whether new or existing. Here’s a guide to the major cost components of health insurance and how they may impact your bill.

Policy News

Biden-Harris Administration Launches 10th Year of Marketplace Open Enrollment with Four Out of Five Customers Eligible for Coverage at $10 or Less, Thanks to Subsidies
Beginning Tuesday, November 1, 2022, consumers are able to sign up for high-quality, affordable health insurance on Marketplace Open Enrollment runs from November 1, 2022, to January 15, 2023. Anyone who enrolls by midnight December 15, 2022 can get full-year coverage that starts January 1, 2023.

HHS Finalizes Physician Payment Rule Strengthening Access to Behavioral Health Services and Whole-Person Care
The U.S. Department of Health and Human Services (HHS), through its Centers for Medicare & Medicaid Services (CMS), is expanding access to behavioral health care, cancer screening coverage, and dental care.

2023 Open Enrollment Period
For individuals and families who buy coverage on their own, open enrollment for 2023 begins November 1. Consumers must enroll by December 15, 2022 for coverage that starts January 1, 2023 or by January 15, 2023 for coverage that starts February 1, 2023.

Third Quarter Reports

CVS Health reports third quarter results
CVS Health Corporation (@cvshealth) announced operating results for the three months ended September 30, 2022.

Humana Reports Third Quarter 2022 Financial Results; Affirms Recent Upward Revision to Full Year 2022 Adjusted EPS Financial Guidance
Humana Inc. reported consolidated pretax results and diluted earnings per common share for the quarter ended September 30, 2022 (3Q22) versus the quarter ended September 30, 2021 (3Q21) and for the nine months ended September 30, 2022 (YTD 2022) versus the nine months ended September 30, 2021 (YTD 2021) as noted in the tables below.

Cigna Reports Strong Third Quarter 2022 Results, Raises 2022 Outlook
Global health services company Cigna Corporation (@Cigna) reported strong third quarter 2022 results reflecting growth in both Evernorth and Cigna Healthcare.