payers

Beyond voluntary promises, standards and a federal mandate for FHIR-based APIs create a powerful framework for real prior authorization reform...

Aetna is following Cigna's lead with a new payment policy that will initially pay inpatient claims at a lower observation...

During a recent Senate HELP Committee hearing, expert witnesses argued that a lack of transparency, vertical integration, and misaligned incentives...

Physician advocacy groups are urging Cigna to withdraw a new reimbursement policy that would automatically downcode high-level E/M claims, arguing...

While revenue cycle executives are skeptical of the voluntary pact between payers to reform prior authorization, the NCQA?s VP of...

For CFOs, the report is both a spotlight on improved performance and cautious reminder of where challenges still lie.

See these tips from the CFO of a health plan and the CFO of a health system on Medicare...

See what the CFO of a health plan and the CFO of a health system think is the solution to...

A recent survey revealed that rising volumes of claim denials are the top threat to provider revenue cycles, while staffing...

UnitedHealth Group has confirmed it is under investigation by the DOJ. For healthcare leaders, the multiple probes into the payer...

Hospitals and health systems must strategically manage rising GLP-1 costs while balancing workforce health and long-term financial sustainability.

A new PwC report projects the medical cost trend will remain high in 2026, driven by soaring drug spending and...