Tag: Managed Care
AAHomecare to grow payer relations team
January 16, 2025HME News Staff
ALEXANDRIA, Va. - AAHomecare is currently searching for a new senior manager of payer relations. The person will be responsible for working in conjunction with payer relations leadership in developing an ongoing industry strategy involving commercial managed care, Medicaid managed care organizations, Medicare Advantage, and state Medicaid programs. AAHomecare is looking for someone to develop ongoing relationships with payers, industry stakeholders at state/regional associations, manufacturers, providers,...
Medtrade preview: New track addresses ‘biggest problem providers have right now’
January 15, 2025Liz Beaulieu, Editor
DALLAS – Medicare Advantage and Medicaid managed care will receive heightened attention at Medtrade this year in a new track of six sessions hosted by AAHomecare and led by members of its Payer Relations Council.
The association has tapped into the providers on the council, including Chair Cadie McGonagill of Lincare, to provide their on-the-ground experience.
“You’ll still hear from me, David (Chandler, vice president of payer relations) and other experts, but...
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...