Payer

Prior authorization is a complex, expensive and burdensome process with clinical and financial impacts across the spectrum of care. Built on processes that are mostly manual, even partial automation of submissions and other routine tasks could ease some of the…

The Choctaw Nation has sued UnitedHealth Group and CVS Health, accusing the companies of  improperly denying reimbursement for pharmacy services.

A new study shows health insurance companies overestimate patient care costs to reduce or avoid paying refunds to policyholders, according to the American Accounting Association.

In March, California handed control of the state's vaccine rollout to insurer Blue Shield. The deal, worth up to $15 million in reimbursements, was met with criticism. Blue Shield CEO Paul Markovich discussed the status of the company's vaccine involvement…

The Kaiser Family Foundation released a study on how insurers performed financially during the pandemic year. Here are eight things to know:

The Delaware Supreme Court rejected Cigna's bid for a $1.85 billion breakup fee from Anthem related to their failed merger agreement, according to Law 360.

The following payer executive changes were announced in April.

CMS released a second payment notice April 30 for 2022 marketplace coverage.

A Kentucky judge threw out $8 billion in Medicaid contracts awarded to six different insurance companies, citing multiple flaws in the state's bidding process, according to the Courier Journal. 

Eligible Cigna members now have access to Ginger, a virtual mental health provider.