Tag: Managed Care
Medtrade preview: Kerry Tyler wants every attendee to leave inspired
December 13, 2024Liz Beaulieu, Editor
DALLAS – For those who are ready to put the work in, Kerry Tyler says inspiration will be ready for the taking at Medtrade 2025, whether it’s through the new Managed Care Track in the conference program, the returning Tech Talks on the show floor or the Welcome to Dallas Reception and other networking events.
“‘Inspiration exists but it has to find you working’ is a Pablo Picasso quote that I like,” said Tyler, associate show director. “It implies...
AAH, Medtrade collaborate on new track
October 3, 2024HME News Staff
WASHINGTON – AAHomecare has collaborated with Medtrade on a new Managed Care track that includes sessions for both beginner and advanced payer relations strategies. The association’s Payer Relations Council developed six classes for the track. “The AAHomecare Payer Relations Council has some of the brightest and most respected payer relations experts in the industry,” says Laura Williard, senior vice president of payer relations for AAHomecare. “By learning...
Florida Medicaid announces additional contracts
July 25, 2024HME News Staff
TALLAHASSEE, Fla. – Florida’s Agency for Healthcare Administration has announced additional statewide Medicaid managed care contracts for five companies following appeals of the original awards in April, AAHomecare reports.
The full scope of awards now includes:
Aetna Better Health of Florida* – Regions D, E, I
Florida Community Care* – Statewide
Humana Medical Plan – Statewide
Molina...
Managed care: Don’t give into ‘extortion’
March 27, 2024Theresa Flaherty, Managing Editor
DALLAS – Managed care plans have gotten a lot more active in auditing and, unfortunately, for providers they often operate under their own playbook, Wayne van Halem told Medtrade attendees on Tuesday.
One thing, in particular, that he’s seeing: an increase in extrapolated overpayments, which are supposed to be appealable, but the plans don’t seem to understand that, he said.
“What they’re doing is extortion: Pay this (extrapolated overpayment) or we’re...
OIG: More oversight needed of Medicaid managed care
July 20, 2023HME News Staff
WASHINGTON – Some people enrolled in Medicaid managed care may not be receiving all of their medically necessary health care services, according to a new study from the Office of Inspector General.
There are three key factors causing concern, the OIG says: the high number and rates of denied prior authorization requests; the limited oversight of prior authorization denials in most states; and the limited access to external medical reviews.
What the OIG found
Overall,...
Big deal, big questions
May 25, 2023Liz Beaulieu, Editor
As we were putting the finishing touches on this June issue, news broke that Humana has contracted with AdaptHealth and Rotech Healthcare, two national HME providers, to provide HME products and services to its Medicare Advantage HMO members.
This is a big deal for a whole lotta reasons.
We’ve all read the headlines. Insurers are increasingly targeting Medicare Advantage plans as a source of growth. Last year, Humana outlined plans to expand its Medicare HMO offerings, specifically,...
Humana contracts with AdaptHealth, Rotech
May 11, 2023HME News Staff
LOUISVILLE, Ky. - Humana has announced agreements with AdaptHealth and Rotech Healthcare to provide home medical equipment services to its Humana Medicare Advantage HMO members.
The two national companies will begin providing services to these members under a value-based structure beginning July 1, with each serving a specific region of the country.
“Partnering with national DME partners under a value-based arrangement aligns with our goal to enhance access to the home care...
NCPA gets behind Drug Transparency in Medicaid Act
March 20, 2023HME News Staff
ALEXANDRIA, Va. – The National Community Pharmacists Association supports bipartisan legislation reintroduced March 17 to improve transparency and prevent the use of “spread pricing” in Medicare managed care programs. Spread pricing is when pharmacy benefit managers overbill the state or Medicaid managed care programs, under-reimburse pharmacies for medications dispensed and retain the difference, the association says. A broad ban on these practices would save the federal government...
IHCS expands to meet demand
June 17, 2022HME News Staff
MIRAMAR, Fla. – Integrated Home Care Services, an independent administrator of home health, DME and home infusion benefits, plans to offer expanded services in 13 states to meet the growing demand for home care. Founded in 2015, IHCS currently serves the home care needs of more than 2.2 million patients through partnerships with managed care organizations and risk-bearing provider organizations across the country. "IHCS was created to better meet the needs of the managed care industry,”...
CAMPS seeks input on managed care transition
April 12, 2022HME News Staff
SACRAMENTO, Calif. – The California Association of Medical Product Suppliers (CAMPS) and the University of California, San Francisco, have launched a survey to collect provider experiences on the state’s transition to a Medi-Cal Managed Care Plan for California Children’s Services (CCS). Anonymous results from the survey, which should only take three to five minutes to complete, will be shared with the California Department of Health Care Services (DHCS). In 2018, DHCS instituted...