Gold Coast Health Plan (GCHP) connected more Medi-Cal members with vital health care screenings and immunizations in 2023, surpassing regulatory health care quality metrics and ranking it as one of ...

The contracts will involve tens of billions of dollars in the coming years, with about 3 million people receiving health care ...

Capital Rx, a pharmacy benefit manager and administrator, has announced Judi Health, the first centralized claims processing ...

“We can point to situations where prior authorization has literally saved lives. There are good docs and there are bad docs ...

Prior authorizations are the way MA managed care plans pre-approve some procedures before they’ll pay for them.

The managed care giant reported a 22% profit increase in 2024 over 2023, as a sharp increase in its Medicare prescription ...

Unless the funding challenges seen in Lynnwood — and at similar facilities in Pierce County — are solved, it could put the ...

Under a managed care arrangement, Medicaid MCOs determine the rates they pay providers for inpatient hospital services.

PROVIDENCE, R.I. (WPRI) — Rhode Island again has canceled a bidding process for a multibillion-dollar contract to run the state’s Medicaid managed care program, the latest installment in an ongoing ...

Centene reported $3.3 billion in 2024 profits as Obamacare enrollment and premium revenue helped overcome a dip in Medicaid ...

17000, Non-Waiver Community First Choice Revision 25-1; Effective Feb. 7, 2025 ...

House lawmakers on Tuesday passed several pieces of legislation that would curb some of the Medicaid savings measures ...