Denials are rising. Work is piling up. And hiring more staff isn’t a sustainable solution. For today’s revenue leaders, small optimizations aren’t enough. It takes a new model — one where AI agents, robots and staff operate in sync to…
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UnitedHealth Group continues to be the largest health insurer in the U.S., with nearly 45 million members in 2025, according to the Peterson-KFF health system tracker. The data is from Mark Farrah Associates and includes enrollment across the individual market,…
Health plans are facing rising claim volumes, staffing challenges, and a surge in rework. Traditional automation, tied to individual applications, can’t keep up. Agentic automation offers a better way. By unifying AI agents, software robots and humans in a coordinated…
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Amy Schulman will join Elevance Health’s board as an independent director Jan. 12, 2026, according to a Dec. 10 news release. She will serve on the audit and finance committees. Ms. Schulman is currently a managing partner at the venture…
CMS’s proposed Medicare Advantage rule for 2027 includes more leeway for hemp coverage. Hemp has low concentrations of tetrahydrocannabinol, as defined by the Agriculture Improvement Act of 2018. Under the proposal, hulled hemp seed, hemp seed protein powder and hemp…
Highmark recently shared how it increased generic and biosimilar access to members, focusing on drugs for multiple sclerosis, cancer and autoimmune conditions. The insurer has been working with CivicaScript, a nonprofit generic drug company it helped found, to offer these…
Nearly 5.8 million people have enrolled in ACA marketplace plans for 2026 coverage, outpacing last year’s enrollment figures at the same point in the open enrollment period, according to new data published Dec. 5 by CMS. Americans have until Dec.…
Reimbursement is tightening, payer negotiations are more volatile and for many hospitals, financial pressure is pushing long-standing tensions to a breaking point. What’s worse, smaller and rural systems often lack the leverage to fight back. This report shares unfiltered insights…
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The One Big Beautiful Bill Act will bring sweeping changes to Medicaid beginning in 2027, while enhanced ACA premium tax credits are set to expire at the end of this year, creating uncertainty for millions of enrollees. California stands to…
The payer-provider relationship is continually evolving. Becker’s connected with 13 health plan leaders to find out which part of that relationship they would change. Like what you see here? Join us at the Spring Payer Issues Roundtable in Chicago. Learn more here. All…