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1. 5th Circuit strikes down parts of No Surprises QPA rule, rejects air ambulance challenge Full story
2. BCBS Association fends off most claims in data-tracking suit Full story
3. 4.8 million IDR disputes later: Learn why payers need a new operating model here.
4. Sentara Health Plans beats lawsuit over 82% ACA rate increase Full story
5. Alignment secures $200M credit line as it eyes plan acquisitions Full story
6. Claims processing and care coordination weren’t built for autonomous AI. See the fix, here.
7. Oscar flags up to 300K ACA disenrollments tied to CMS fraud crackdown Full story
8. International fugitive pleads guilty in $1.2B Medicare telehealth scheme Full story
9. CMS to end Medicaid, CHIP funding for pediatric gender-affirming care Full story
10. BCBS Illinois exec to depart for kidney foundation’s CEO role Full story
11. UnitedHealth sets quarterly dividend Full story
12. When the NEMT audit arrives, your health plan is the responsible party. Prepare here.
Becker’s Learning Opportunities
13. AI fatigue is costing payers more than they think. Find out why here.
14. CMS APIs go live January 2027. Simplify prior authorization without disrupting provider workflows here.
15. Payers cut operational costs 15-20% with integrated infrastructure. See how here.
16. Becker’s August webinar lineup: patient flow, pharmacy access and denials. See the sessions here.
Apply to attend complimentary as a guest reviewer here! Opportunity exclusive to those directly employed by a payer, payvider, accountable care organization, or clinically integrated network.
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