Payer

Utilization management (UM) has become a huge administrative burden for both providers and payers due to multiple data sources and manual processes. By using artificial intelligence (AI) technology and real-time data, all parties can significantly reduce current utilization management review…

The Health Resources and Services Administration should do more to clarify which contraceptives are required to be covered at no cost under the ACA and make sure new methods are added to coverage requirements, healthcare attorneys write in an opinion…

Cigna is launching a new concierge service, Pathwell, combining elements from Evernorth, its health services arm, to treat complex conditions. 

A Delaware retiree advocacy group is suing the state over its decision to move retired state employees to a Medicare Advantage plan managed by Highmark Delaware, Delaware Public Radio reported Sept. 27. 

Cigna will not implement a paperwork demand that was criticized by the California Medical Association and American Medical Association. 

Most of the nation's largest health payers have a single CEO at the helm and operate under one name across many states. In contrast, Blue Cross and Blue Shield payers function as smaller, independent companies, though they are often the…

Aetna is expanding eligibility for its Resources for Living program, which connects members to community resources, to support members affected by Hurricane Ian. 

Western Sky Community Care is launching a virtual doula network for Medicaid members in New Mexico, the Centene subsidiary said Sept. 27. 

Nearly half of Medicaid managed care plans' medical loss ratio reports submitted to states were incomplete, according to a report from the HHS inspector general's office.

Payers and their venture arms have spent 2022 investing in a variety of new healthcare companies, including digital insurance marketplaces and behavioral health providers.