Payor Relations

Services Payor News Meet the Team

Payor Relations works to support the Managed Care Department and UTMB by acting as a liaison between the hospital system and the insurance company (Payor/Payer). This small team handles several key responsibilities to ensure proper communication and escalation of issues between both parties.

Services

Claims Resolution and Escalation

Working along-side Revenue Cycle Operations, Payor Relations acts as a point of contact for resolving claim denials, underpayments, and other payment discrepancies with insurance payers. Payor Relations collaborates with Revenue Cycle Operations to investigate issues, initiate escalations, and expedite payments.

Payor Communication

Serving as a liaison between UTMB and payors to address operational issues, answer questions, and clarify policy changes. Our team works to facilitate clear communication to maintain positive working relationships.

Education

Assisting in educating internal staff on payor guidelines, policies, and any updates to reimbursement procedures, ensuring that departments are informed of changes that may impact claims or revenue.

Insurance Information

Insurance List

Red/Green Report

Payor News

Health Care Services Corporation acquisition of Cigna Healthcare Medicare business complete

September 21, 2025 • 12:15 a.m. Source: Provider Newsroom,

On March 19, 2025, The Cigna Group completed the sale of its Medicare and CareAllies businesses to Health Care Service Corporation (HCSC). This divestment streamlines Cigna’s portfolio and focuses its efforts on innovation. The transaction does not affect Cigna’s commercial business or existing contracts. For 2025, processes and coverage for Medicare and CareAllies customers remain unchanged with no disruption. Providers can refer to HCSC contacts for patients under HCSC-managed plans. Both Cigna and HCSC are committed to a smooth transition and value ongoing partnerships.

Superior Healthplan News: Transition of Utilization Review from TurningPoint to Evolent Effective for Cardiology Procedures beginning July 1, 2025

April 1, 2025 • 8:00 a.m. Source: Superior HealthPlan, Cardiology Procedures: Transition of Utilization Review from TurningPoint to Evolent Effective for Service Dates beginning July 1, 2025

Effective 7/1/25, Evolent Specialty Services, Inc., will now manage the Utilization Review of cardiology services and procedures, taking the place of TurningPoint Healthcare Solutions, LLC. After 7/1/25, prior authorizations for applicable non-emergent, cardiology services must now be requested through Evolent. This change applies to Superior HealthPlan Medicaid (STAR, STAR Health, STAR+PLUS), STAR+PLUS Medicare-Medicaid Plan (MMP) and Wellcare By Allwell Medicare members aged 21 and older, and Ambetter from Superior HealthPlan members aged 18 and older.