Health insurance

BCBSNC wins State Health Plan TPA, PBM contracts

In addition to voting on preferred provider hospital systems, benefit changes, and premiums for 2027 at its Friday board meeting, the North Carolina State Health Plan Board of Trustees also awarded the Third-Party Administrator (TPA) and Pharmacy Benefit Manager (PBM) contracts to Blue Cross Blue Shield of North Carolina (BCBSNC) effective January 2028.This will bring BCBSNC back as the TPA after a three-year hiatus. CVS Caremark is the current PBM for the SHP.

Theresa Opeka

News

State Health Plan OKs premium hikes, preferred providers

On Friday, the North Carolina State Plan Board of Trustees (SHP) voted on what are being called monumental changes to the Plan over the next few years, including preferred provider hospital systems, benefit changes, and premiums for 2027, and the announcement of a Third Party Administrator (TPA) and Pharmacy Benefit Manager (PBM) for 2028, in an effort to make improvements and reduce overall costs for the nearly 750,000 members covered by the Plan.

Theresa Opeka

Opinion

NC’s healthcare crisis: Too much spending, too little care

The two problems that remain are clear: there are too many middlemen, and too little money is reaching the people who actually deliver care to NC residents.

Kerry Willis

News

Stein creates bipartisan healthcare affordability commission

On Tuesday, Democratic Gov. Josh Stein signed an executive order creating the bipartisan Health Care Affordability Commission that he said will look at ways to make healthcare more affordable for North Carolinians.

Theresa Opeka

News

Senate advances bill limiting AI in healthcare billing

NC senators advanced a bill limiting AI in health care billing and insurance denials, citing concerns over upcoding and patient impacts.

Andrew Pomeranz

News

State Health Plan transgender care lawsuit dismissed

A federal lawsuit challenging the North Carolina State Health Plan’s exclusion of coverage for treatments typically sought by transgender patients has been dismissed.

CJ Staff

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News

NC Senate advances Medicaid oversight bill

Senate bill would expand Medicaid provider controls amid scrutiny of rising autism therapy costs and concerns over fraud, billing, and oversight.

Andrew Pomeranz

News

State Health Plan raises Medicare rates, shifts provider tiers to cut costs

At their board meeting on Friday, the North Carolina State Health Plan Board of Trustees voted unanimously to raise rates on its Medicare Advantage plans for older workers and retirees and discussed a new tier system for providers in the state.

Theresa Opeka

Opinion

Prior authorization harms NC healthcare

Prior authorization allows insurance companies to delay treatment, overrule clinical judgment, and drain time from the exam room.

Kerry Willis

Opinion

NC Medicaid is improving under managed care system

More than 40 states have adopted managed Medicaid because it works. Compared to the old fee-for-service approach, managed Medicaid delivers better care coordination, stronger oversight, and more responsible stewardship of taxpayer dollars.

Peter T. Daniel

Opinion

Mergers only make hospital monopolies worse

Healthy competition benefits consumers through lower prices and improved quality. With NC's hospital markets already highly concentrated, officials should regard further mergers with suspicion, especially those hurried through under the cloak of darkness.

Brian Miller, Ardis Watkins

Opinion

Stop the facility-fee shakedown

If a hospital can’t afford to provide the service for the lower charge provided by private companies, then maybe there are service lines a hospital doesn’t need to be in.

Kerry Willis

BCBSNC wins State Health Plan TPA, PBM contracts

State Health Plan OKs premium hikes, preferred providers

NC’s healthcare crisis: Too much spending, too little care

Stein creates bipartisan healthcare affordability commission

Senate advances bill limiting AI in healthcare billing

State Health Plan transgender care lawsuit dismissed

Help Support Non-profit Journalism & Donate Today

NC Senate advances Medicaid oversight bill

State Health Plan raises Medicare rates, shifts provider tiers to cut costs

Prior authorization harms NC healthcare

NC Medicaid is improving under managed care system

Mergers only make hospital monopolies worse

Stop the facility-fee shakedown

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