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Elevance Health’s Blue Cross Blue Shield of Georgia is suing HaloMD, Hospitalist Medicine Physicians of Georgia and Sound Physicians Emergency…
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Elevance Health’s Blue Cross Blue Shield of Georgia is suing HaloMD, Hospitalist Medicine Physicians of Georgia and Sound Physicians Emergency Medicine of Georgia, alleging the three organizations exploited the No Surprises Act’s Independent Dispute Resolution process for financial gain. The…
From its CEO’s resignation to a reported federal investigation into its Medicare Advantage business practices, May was a challenging month for UnitedHealth Group. Here are four things to know: Andrew Witty resigns UnitedHealth Group announced May 13 that CEO Andrew…
Highmark Health Plans reported $6.1 billion in operating revenue and a $9 million operating loss in the first quarter of 2025, citing elevated utilization and continued industrywide pressures that carried over from last year. Parent company Highmark Health reported $8…
May is Women’s Health Month, a time dedicated to raising awareness about the unique health challenges faced by women. As we end the month, this is a good time to look at the accumulating evidence that shows significant disparities in…
Payers are trimming their workforces and cutting jobs due to financial or operational challenges, along with contract losses.
UnitedHealthcare and Providence, R.I.-based Brown University Health will go out of network on July 1 for Medicare Advantage plans without a new contract in place. Brown’s hospitals will be out of network for UnitedHealth’s MA plans, including D-SNP and group…
The clinical data goldmine: How HIEs are poised to transform payer efficiency & patient outcomes
As healthcare becomes increasingly data-driven, payers are turning to clinical health record data to strengthen claims processing, care coordination and risk management. This shift reflects a broader industry trend toward more integrated, real-time data use across the care continuum. With…
Elevance Health’s Carelon is ceasing operations in Ireland and will lay off 300 employees in Limerick, the Irish Times reported May 28. “After carefully considering alternatives and conducting a consultation process with employee representatives, we have made the difficult decision…
Blue Cross Blue Shield of Minnesota and Blue Cross Blue Shield of North Dakota are the first two insurers to earn URAC’s Mental Health/Substance Use Disorder Parity Accreditation. The certification is the only program of its kind in the U.S.,…
Priority Health is partnering with Virta Health on three new solutions aimed at addressing demand for weight management options and diabetes support among employers and employees. The solutions include nutrition programs and multi-specialty clinical support to help members lose weight…