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Pennsylvania Department of Human Services Prior Authorization 

PURPOSE:   The purpose of this bulletin is to issue updated handbook pages that include the requirements for prior authorization and…

Nov Industry Notes: Elevance to Penalize Facilities For Out-of-network Providers 

Elevance Health (Anthem) will begin penalizing healthcare facilities in 11 states starting Jan. 1, 2026, for using out-of-network providers for…

What to Know About Cigna’s and Aetna’s New Downcoding Policies 

Cigna and Aetna are drawing provider backlash for new payment policies that reduce reimbursements. Cigna is automatically “downcoding” six Evaluation…