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Payer

Infographic: Payer & Provider Readiness for CMS-0057-F
While health plans make headway on upcoming interoperability mandates associated with the Advancing Interoperability and Improving Prior Authorization Final Rule,...
cfo-healthcare-finance
Farm Bureau Plans Are a Less Pricey Alternative to ACA Coverage — With Trade-Offs

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cfo-healthcare-finance
States Face Another Challenge With Medicaid Work Rules: Staffing Shortages
Katie Crouch says calling her state?s Medicaid agency to get information about her benefits can feel like a series of...
CMS' Medicare Advantage Final Rule Raises Stakes for Payers, Providers
A stronger-than-expected rate increase benefits health plan funding, but updates to the star ratings system aims to create more incentive...
payer-healthcare
Immigrant Seniors Lose Medicare Coverage Despite Paying for It
OAKLAND, Calif. ? Rosa María Carranza leaned forward to hold a 3-year-old?s back as the girl climbed a rock in...
Why Memorial Hermann Is Digging In During Its Blue Cross Contract Fight
By going out of network with Blue Cross Blue Shield of Texas, the Houston-based health system is testing how much...
Trump's One Big Beautiful Bill Act Darkens Outlook for Government-Backed Clinics
Many are bracing for fallout from the law Trump signed last year, which could cost the nonprofit health centers $32...
OPM calls on federal insurance carriers to promote ‘well care,’ cut costs
A new OPM call letter outlined what FEHB and PSHB carriers should take into account as they work to finalize...
Opinion | He Was an Insurance Executive. She’s a Doctor. They’re Divided.
Frustration with a broken health care system has many Americans blaming insurance companies.
Washington State Ousted This Health Insurance Lookalike. In Oregon, It Carries On.
From one vantage, the story of Zion HealthShare shows Washington to be an intrusive nanny state. From another perspective, Oregon...
Trump administration finalizes better-than-feared Medicare Advantage payment rate in boost to health insurers
The Trump administration will increase average Medicare Advantage payments by 2.48%, or more than $13 billion, in 2027, according to...
Jefferson Health sues Aetna over controversial Medicare Advantage hospital payment policy
Jefferson Health sued Aetna Monday over a controversial new policy that reduces payments for hospital stays for Medicare Advantage patients...
Health insurers rejected 19% of claims for exchange plans
Health insurance companies rejected almost one-in-five in-network claims for plans purchased on the federal exchange in 2024.
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