Lead story · Week of Oct 19–23, 2026
UnitedHealthcare and Humana End MA Plans for About 1 Million Seniors in 2027
Verify eligibility on every MA patient the first weeks of January.
Week of Oct 19–23, 2026Free weekly briefing
Payer changes, explained before they become denials.
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This Week
Full issue →Every item sourced and dated; anything unverified is labeled.
Medicare pay & CMS
Federal Register
CMS Proposes MA Provider-Directory Rules, and the AMA Flags the Fine Print
Comments are due Dec. 15, 2026 (5 p.m. ET).
Insurance Business
Centene Sues CMS Over 2027 Star Ratings ($448 Million at Stake)
Star bonuses fund MA benefits and network rates, and Centene is already exiting hundreds of MA counties for 2027.
Prior auth
Cigna October 2026 Policy Updates
Cigna Added 37 Prior-Auth Codes Effective Oct. 1, and Told Everyone Oct. 16
Check the Master Precertification List against any Oct. 1-forward Cigna cases before the denials do it for you.
Columbus Dispatch
WISeR, Medicare's AI Prior-Auth Pilot, Left Ohio Patients Waiting Months
Texas is a WISeR state too. Track every WISeR request and its turnaround.
Yahoo Finance/Zacks
Prior-Auth "Streamlining" Watch: Aetna and Big Employers
It's voluntary, not a mandate.
AHA News
Federal QPA Audits: CareSource Got 952 of 952 Sampled QPAs Wrong
Useful ammunition if you're in IDR: QPAs are not gospel.
Elevance Health
Elevance Beats and Raises
Payers aren't hurting the way their rate letters suggest.
Quick hits In the issue →
- BCBSTX posted its updated IONM reimbursement policy (RP032) on Oct. 20 with an effective date of Oct. 9. Yes, it took effect before it was posted. Remote IONM needs a licensed physician outside the surgical team with live video and two-way audio; technician and equipment costs aren't separately payable. bcbstx.com ↗ (policy PDF: bcbstx.com ↗ )
- TMHP (Texas Medicaid's claims system) goes dark Sunday, Oct. 25, 2 p.m. CT to 4 a.m. CT Monday, Oct. 26. Submit before Sunday afternoon (Oct 19, 2026). tmhp.com ↗
- HHS v. Texas Medical Association (No. 26-491): the government has asked the Supreme Court to review the Fifth Circuit's ruling in the QPA case, on the remedy question; TMA's response is due Nov. 13. supremecourt.gov ↗
Texas
Texas page →Watch List
Details →- Pending
Still Waiting: 2027 Physician Fee Schedule
We'll cover the final the day it drops.
Opinion The Weekly Take
The Rules Run Backward
Practices have to be right up front. Payers get to be right after the fact.
Read the Weekly TakeIf you run an independent practice, you already know how this works: you have to be right ahead of time, and the payer gets to be right after the fact.
Free · Every Friday
Know the payer change before the denial does.
One short email a week. Sourced, dated, and honest about what we haven't verified.
- Fee schedule, prior auth and audit changes
- Texas payer notices, tracked separately
- Unverified items labeled, never guessed