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Payer Issues

September 9, 2025 1. 'Denial is not a strategy in 2025': Why this payer is calling the insurance industry broken Full story 2. UnitedHealthcare expects most Medicare Advantage members to be in 4+ star plans in 2026 Full story 3.…

September 4, 2025 1. Medicare Advantage risk adjustment 'a failing system': Report Full story 2. CMS expands eligibility for catastrophic health plans Full story 3. Pressure to eliminate ghost networks is rising. See how payers are responding: here. 4. Florida Blue,…

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September 2, 2025 1. Cigna invests $3.5B in former Walgreens specialty pharmacy subsidiary Full story 2. Medicare Advantage plans keep senior care costs down in California: UCLA study Full story 3. BCBS leaders: Streamline prior auth with AI-powered data strategies.…

August 29, 2025 1. UnitedHealthcare sues Radiology Partners over No Surprises claims Full story 2. Medical associations push back on Cigna's new downcoding policy Full story 3. AI is moving payment integrity from automation to transformation—see how it’s reshaping accuracy…

August 26, 2025 1. Johns Hopkins goes out of network with UnitedHealthcare Full story 2. Payer mix in the largest for-profit health systems Full story 3. AI is moving payment integrity from automation to transformation—see how it’s reshaping accuracy and…

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