MA Plans Vanish, Directories Get a Rulebook, and Cigna Posts PA Changes After the Fact

UnitedHealthcare and Humana End MA Plans for About 1 Million Seniors in 2027

Published: Oct 20, 2026 (Fortune/Healthcare Brew). Oct 23, 2026 (CBS News).

About 390,000 UHC members and about 600,000 Humana members are in plans that end Dec. 31; UHC's cuts focus on PPOs. Expect patients walking in January with new plan cards, narrower HMO networks and fresh prior-auth rules.

Takeaway: Verify eligibility on every MA patient the first weeks of January.

CMS Proposes MA Provider-Directory Rules, and the AMA Flags the Fine Print

Published: Oct 20, 2026 (Federal Register). Oct 23, 2026 (AMA).

CMS-4214-P (91 FR 66408) would require MA plans to verify directories at least every 90 days, report accuracy scores publicly, and protect enrollees' cost-sharing when they rely on a wrong listing. The AMA warns the proposal would push plans to add contract terms requiring physicians to keep directory data accurate and supply appointment-scheduling documentation.

Takeaway: Comments are due Dec. 15, 2026 (5 p.m. ET).

Federal QPA Audits: CareSource Got 952 of 952 Sampled QPAs Wrong

Published: Oct 20, 2026 (AHA News). Oct 22, 2026 (TechTarget).

CMS's insurance oversight office (CCIIO) published two No Surprises Act audits. CareSource (Indiana) used usual-and-customary rates instead of the required median in-network rate in every sampled determination and left required QPA info off 735 payment/denial notices. The Ohio SERS audit (Aetna-administered) missed two of six air-ambulance claims that were NSA-eligible.

Takeaway: Useful ammunition if you're in IDR: QPAs are not gospel.

Cigna Added 37 Prior-Auth Codes Effective Oct. 1, and Told Everyone Oct. 16

Published: Cigna October 2026 Policy Updates

Cigna's October policy update adds 20 CPT and 17 HCPCS codes to precertification, effective Oct. 1, in a notice posted after that date that doesn't list the codes.

Takeaway: Check the Master Precertification List against any Oct. 1-forward Cigna cases before the denials do it for you.

Centene Sues CMS Over 2027 Star Ratings ($448 Million at Stake)

Published: Oct 23, 2026

Centene filed Oct. 22 in the Southern District of Georgia, arguing CMS used 17 unlawful measures, the same kind a court struck down for Clover in May.

Takeaway: Star bonuses fund MA benefits and network rates, and Centene is already exiting hundreds of MA counties for 2027.

WISeR, Medicare's AI Prior-Auth Pilot, Left Ohio Patients Waiting Months

Published: Oct 22, 2026

Records reviewed by the Columbus Dispatch show the Ohio vendor warned CMS it wasn't ready, providers waited more than a month on some requests, and patients waited in pain. CMS says early issues are resolved.

Takeaway: Texas is a WISeR state too. Track every WISeR request and its turnaround.

Prior-Auth "Streamlining" Watch: Aetna and Big Employers

Published: Oct 20, 2026 (Zacks). Oct 21, 2026 (CMS).

Aetna says 77% of its electronic prior auths are approved in real time and plans to extend bundled prior auth (which includes a hip/knee arthroplasty bundle) to Medicare and commercial members in the first half of 2027. Separately, CMS and the Labor Department announced Amazon, Axon, Google, Meta and Oracle backing electronic prior auth for self-funded plans.

Takeaway: It's voluntary, not a mandate.

Elevance Beats and Raises

Published: Oct 21, 2026

Q3 adjusted EPS of $6.99; full-year adjusted guidance raised to at least $29.00.

Takeaway: Payers aren't hurting the way their rate letters suggest.

• 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. https://www.bcbstx.com/provider/education/education/news/2026/10-20-2026-reimbursement-policy-updates (policy PDF: https://www.bcbstx.com/docs/provider/tx/standards/clinical-pay-coding/2026/rp032-10-9-2026.pdf )
• 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). https://www.tmhp.com/news/2026-10-19-planned-system-maintenance-outage-moved-october-25-2026
• 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. https://www.supremecourt.gov/docket/docketfiles/html/public/26-491.html