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Tag · managed care

Items in the last 60 days tagged "managed care" with substantive content available.

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DOJ Press Releases (all components) · Sep 30, 2026
Score 100
Independence Blue Cross Agrees to Pay $22.5 Million to Resolve Allegations That It Violated the False Claims Act by Submitting or Failing to Correct Inaccurate Diagnoses for Medicare Advantage Enrollees
PrimaryAuthoritative depthDOJ FCA PA False Claims Act DOJ settlement Fraud waste abuse Managed care
OIG Reports (Audits + Evaluations) · Sep 8, 2026
Score 96
OIG Report (Audit): South Carolina Did Not Ensure That Selected Medicaid Managed Care Organizations Complied With Mental Health and Substance Use Disorder Parity Requirements Related to Prior Authorization
PrimaryHHS OIG MHPAEA Managed care State Medicaid
DOJ Press Releases (all components) · Sep 30, 2026
Score 94
Independence Blue Cross to Pay $22.5M to Resolve False Claims Act Allegations
PrimaryAuthoritative depthDOJ FCA PA False Claims Act DOJ settlement Fraud waste abuse Managed care
OIG Reports (Audits + Evaluations) · Oct 1, 2026
Score 93
OIG Report (Audit): Medicare Advantage Organizations and Prescription Drug Plans Paid $72 Million During a 3-Year Period for Services Associated With Excluded Providers or Individuals Convicted of Certain Felonies
PrimaryHHS OIG OIG enforcement OIG exclusion Fraud waste abuse Managed care
Virginia DMAS (Medicaid) · Sep 30, 2026
Score 93
Renewal of Virginia's Building and Transforming Coverage, Services, and Supports for a Healthier Virginia (BTCSSHV) Section 1115 Demonstration and Approval of New Serious Mental Illness 1115 (SMI) Waiver Announcement
PrimaryAuthoritative depthState Medicaid VA State Medicaid Managed care
Virginia DMAS (Medicaid) · Sep 25, 2026
Score 89
Changes to Gender Dysphoria Coverage
PrimaryAuthoritative depthState Medicaid VA State Medicaid Managed care
Michigan Medicaid · Oct 16, 2026
Score 87
MMP 26-39
PrimaryAuthoritative depthState Medicaid MI Managed care State Medicaid
Michigan Medicaid · Sep 15, 2026
Score 87
MMP 26-12
PrimaryAuthoritative depthState Medicaid MI State Medicaid Managed care
Texas Office of Inspector General (HHSC) · Aug 27, 2026
Score 86
Reporting fraud, waste and abuse to your MCO’s special investigative unit
PrimaryState OIG MFCU TX Fraud waste abuse Managed care State Medicaid
Kansas Medical Assistance Program · Oct 14, 2026
Score 85
UPDATED 22252, General
PrimaryAuthoritative depthState Medicaid KS Billing, coding and payment Managed care State Medicaid
Texas Office of Inspector General (HHSC) · Sep 17, 2026
Score 85
Dental anesthesia billing
PrimaryAuthoritative depthState OIG TX State Medicaid Managed care Billing, coding and payment
Louisiana Medicaid · Oct 24, 2026
Score 83
Informational Bulletin 25-32
PrimaryAuthoritative depthState Medicaid LA Managed care State Medicaid
Louisiana Medicaid · Oct 24, 2026
Score 80
Informational Bulletin 25-32
PrimaryAuthoritative depthState Medicaid LA Managed care State Medicaid
Louisiana Medicaid · Oct 24, 2026
Score 80
Informational Bulletin 26-3
PrimaryAuthoritative depthState Medicaid LA Managed care State Medicaid
Louisiana Medicaid · Oct 24, 2026
Score 80
Informational Bulletin 26-12
PrimaryAuthoritative depthState Medicaid LA Managed care State Medicaid
Virginia DMAS (Medicaid) · Sep 25, 2026
Score 80
Updates to the Peer Recovery Support Services Supplement
PrimaryAuthoritative depthState Medicaid VA State Medicaid Managed care
OIG Reports (Audits + Evaluations) · Sep 24, 2026
Score 80
OIG Report (OEI): Medicaid Managed Care: CMS’s Accuracy Check Process For State-Submitted Medical Loss Ratio Data Has Limitations
PrimaryHHS OIG Managed care OIG enforcement
Michigan Medicaid · Sep 15, 2026
Score 80
MMP 26-14
PrimaryAuthoritative depthState Medicaid MI State Medicaid Managed care
Louisiana Medicaid · Oct 24, 2026
Score 78
Informational Bulletin 26-3
PrimaryAuthoritative depthState Medicaid LA Managed care State Medicaid
Oregon Health Authority · Oct 21, 2026
Score 76
Oregon Health Plan rates for 2027 released
PrimaryAuthoritative depthState agency OR State Medicaid Managed care
Oregon Health Authority: Tools for OHP Health Plans (coordinated care organization announcements) · Oct 17, 2026
Score 76
Care Coordination Data Guidance for the Healthier Oregon Transition
PrimaryAuthoritative depthState Medicaid OR Managed care State Medicaid
Oregon Health Authority: Oregon Health Plan Temporary Rule Filings (OAR chapter 410) · Oct 3, 2026
Score 75
141-3850-10012026.PDF: OAR 410-141-3850 rule changes updating transition of care rule for OHP members between coordinated care organizations (CCOs), or between CCOs and OHP Open Card
PrimaryAuthoritative depthState register OR State Medicaid Managed care
Louisiana Medicaid · Oct 24, 2026
Score 73
Informational Bulletin 26-6
PrimaryAuthoritative depthState Medicaid LA Managed care State Medicaid
Michigan Medicaid · Sep 15, 2026
Score 73
MMP 26-26
PrimaryAuthoritative depthState Medicaid MI State Medicaid Managed care
Colorado Division of Insurance · Sep 10, 2026
Score 71
Notice of Adoption - Bulletin B-4.159 Medicare Advantage Plans with Service Area Reductions in CY27
PrimaryAuthoritative depthState insurance dept CO Managed care
Oregon Health Authority: Tools for OHP Health Plans (coordinated care organization announcements) · Oct 17, 2026
Score 70
Health Related Social Needs (HRSN) Data Submission Guidance for Healthier Oregon Transition of Care
PrimaryAuthoritative depthState Medicaid OR Managed care State Medicaid
Virginia DMAS (Medicaid) · Sep 26, 2026
Score 70
Nursing Facility Manual Chapter 4
PrimaryAuthoritative depthState Medicaid VA State Medicaid Managed care
Colorado Division of Insurance · Sep 1, 2026
Score 68
Request for Comment on DRAFT Proposed Revised Bulletin B-4.XXX Medicare Advantage Plans with Service Area Reductions in CY27
PrimaryAuthoritative depthState insurance dept CO Managed care
MassHealth · Oct 17, 2026
Score 66
All Provider Bulletin 422: Changes to MassHealth’s Accountable Care Organizations on January 1, 2027, Open PDF file, 326.61 KB
PrimaryAuthoritative depthState Medicaid MA Managed care State Medicaid
North Carolina DHHS · Oct 7, 2026
Score 66
Governor Stein, NCDHHS Announce More Than $17 Million Investment in Mental Health Services Through North Carolina’s Rural Health Transformation Program
PrimaryAuthoritative depthState agency NC Managed care State Medicaid
OIG Reports (Audits + Evaluations) · Sep 28, 2026
Score 65
OIG Report (Audit): Medicare Advantage Compliance Audit of Specific Diagnosis Codes That UnitedHealthcare Benefits of Texas, Inc. (Contract H0609), Submitted to CMS
PrimaryAuthoritative depthHHS OIG OIG enforcement Managed care Fraud waste abuse
OIG Reports (Audits + Evaluations) · Sep 14, 2026
Score 65
OIG Report (OEI): Medicare Advantage Organizations and CMS Can Do More To Prevent Durable Medical Equipment Fraud in Medicare Advantage
PrimaryAuthoritative depthHHS OIG Fraud waste abuse Managed care
Kansas Medical Assistance Program · Sep 13, 2026
Score 65
KanCare 3.0 Open Claims Resolution Log
PrimaryState Medicaid KS Billing, coding and payment Managed care State Medicaid
Kansas Medical Assistance Program · Sep 13, 2026
Score 65
KanCare 3.0 Open Claims Resolution Log
PrimaryState Medicaid KS Billing, coding and payment Managed care State Medicaid
Louisiana Medicaid · Oct 24, 2026
Score 63
Informational Bulletin 25-33
PrimaryAuthoritative depthState Medicaid LA Managed care State Medicaid
Kansas Medical Assistance Program · Sep 13, 2026
Score 63
KanCare 3.0 Closed Claims Resolution Log
PrimaryState Medicaid KS Billing, coding and payment Managed care State Medicaid
Hawaii Med-QUEST Division · Oct 3, 2026
Score 62
Notice of Annual Public Forum, QUEST Integration Section 1115 Demonstration Project
PrimaryAuthoritative depthState Medicaid HIPAA HI State Medicaid Managed care
Kansas Medical Assistance Program · Sep 13, 2026
Score 61
KanCare 3.0 Open Claims Resolution Log
PrimaryState Medicaid KS Billing, coding and payment Fraud waste abuse Managed care State Medicaid
Kansas Medical Assistance Program · Sep 13, 2026
Score 61
KanCare 3.0 Closed Claims Resolution Log
PrimaryState Medicaid KS Billing, coding and payment Long-term care Managed care State Medicaid
New Jersey Legislature (healthcare bills) · Oct 17, 2026
Score 60
NJ A 3066: Requires DHS to review, and implement certain improvements to, Medicaid Managed Long-Term Services and Supports Program and to establish public-facing report card of managed care organization's coordination of program.
PrimaryState legislature NJ Managed care State Medicaid
Kansas Medical Assistance Program · Oct 9, 2026
Score 60
KanCare 3.0 Open Claims Resolution Log
PrimaryState Medicaid KS Managed care State Medicaid
Oregon Medicaid · Oct 3, 2026
Score 60
Non-Emergency Medical Transportation Data Guidance for the Healthier Oregon Transition
PrimaryAuthoritative depthState Medicaid OR State Medicaid Managed care
New York Legislature (healthcare bills) · Oct 1, 2026
Score 60
NY A 9099: Relates to health care payment amounts
PrimaryState legislature NY Health plan or payer Managed care
Massachusetts Legislature (healthcare bills) · Sep 2, 2026
Score 60
MA SD 4160: Community Behavioral Health Center FY26 Report
PrimaryState legislature MA Managed care State Medicaid
Kansas Medical Assistance Program · Oct 23, 2026
Score 58
KanCare 3.0 Open Claims Resolution Log
PrimaryAuthoritative depthState Medicaid KS Billing, coding and payment Managed care State Medicaid
OIG Reports (Audits + Evaluations) · Sep 23, 2026
Score 58
OIG Report (Audit): New York Made Unallowable Managed Care Capitation Payments on Behalf of Incarcerated Medicaid Enrollees
PrimaryAuthoritative depthHHS OIG OIG enforcement State Medicaid Managed care Fraud waste abuse
Louisiana Medicaid · Oct 24, 2026
Score 56
Informational Bulletin 26-4
PrimaryAuthoritative depthState Medicaid LA Managed care State Medicaid
Louisiana Medicaid · Oct 24, 2026
Score 56
Informational Bulletin 25-35
PrimaryAuthoritative depthState Medicaid LA Managed care State Medicaid
Kansas Medical Assistance Program · Oct 16, 2026
Score 56
KanCare 3.0 Open Claims Resolution Log
PrimaryState Medicaid KS Billing, coding and payment Managed care State Medicaid
Virginia DMAS (Medicaid) · Oct 9, 2026
Score 56
Updates to Pharmacy Chapter 4 Provider Manual
PrimaryAuthoritative depthState Medicaid VA Managed care State Medicaid
Virginia DMAS (Medicaid) · Sep 25, 2026
Score 56
Service Authorization (Appendix D) Update
PrimaryAuthoritative depthState Medicaid VA State Medicaid Managed care Information blocking
Kansas Medical Assistance Program · Sep 24, 2026
Score 56
KanCare 3.0 Open Claims Resolution Log
PrimaryAuthoritative depthState Medicaid KS State Medicaid Managed care
Kansas Medical Assistance Program · Sep 13, 2026
Score 56
KanCare 3.0 Open Claims Resolution Log
PrimaryState Medicaid KS Managed care State Medicaid
Kansas Medical Assistance Program · Sep 13, 2026
Score 56
KanCare 3.0 Open Claims Resolution Log
PrimaryState Medicaid KS State Medicaid Managed care Billing, coding and payment
Michigan Medicaid · Sep 15, 2026
Score 55
MMP 26-37
PrimaryState Medicaid MI State Medicaid Managed care
Kansas Medical Assistance Program · Sep 13, 2026
Score 55
KanCare 3.0 Closed Claims Resolution Log
PrimaryState Medicaid KS Billing, coding and payment Managed care State Medicaid
Louisiana Medicaid · Oct 24, 2026
Score 53
Informational Bulletin 26-16
PrimaryAuthoritative depthState Medicaid LA Managed care State Medicaid
Pennsylvania Office of Mental Health and Substance Abuse Services · Sep 24, 2026
Score 53
Critical Incident Management
PrimaryState behavioral health PA Managed care
Kansas Medical Assistance Program · Oct 23, 2026
Score 51
KanCare 3.0 Closed Claims Resolution Log
PrimaryAuthoritative depthState Medicaid KS Billing, coding and payment Managed care State Medicaid
Louisiana Medicaid · Oct 24, 2026
Score 50
Informational Bulletin 26-2
PrimaryState Medicaid LA Managed care State Medicaid