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Health Insurance › Fraud › Insurance Claims

Davis Wright Tremaine LLP

Anthem's New Chargemaster-Based Claim Edits: Which Charges and Providers Will Anthem's New Process Target and How Will It Impact...

Davis Wright Tremaine LLP on

Effective August 1, 2025, Anthem will implement a new claims-editing process that adjusts payments for Medicare Advantage (MA) claims based on an undisclosed, customized chargemaster table. The announcement identifies claims...more

Stevens & Lee

New Changes to Medicare and Private Prior Authorization Processes

Stevens & Lee on

Both the Centers for Medicare & Medicaid Services (CMS) and dozens of the nation’s largest insurance companies have revealed upcoming changes to their prior authorization processes. These changes aim to reduce the prevalence...more

Wiley Rein LLP

For the Record: Cyber Coverage “For” a Security Breach is Ambiguous under New Mexico Law

Wiley Rein LLP on

The New Mexico Court of Appeals has held that cyber policy language affording coverage “for” a security breach was ambiguous and must be construed broadly to provide coverage for a breach of contract claim “because of,”...more

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