UnitedHealthcare is the latest insurer calling for an overhaul of the No Surprises Act’s arbitration system. “The IDR process is not working, certainly not as Congress intended it, and it needs to be reformed,” Dan Kueter, CEO of the insurer’s…

The American Medical Association is launching an initiative to develop and deploy SNOMED CT to CPT terminology mappings that support electronic prior authorization. The project aims to reduce administrative burden for physicians and help patients receive timely care by connecting…

Regence BlueCross BlueShield of Oregon retained more than 98% of its employer-sponsored group membership in 2025, the top mark among all 33 Blue Cross Blue Shield plans in what is the most competitive market tier. The achievement came during a…

Approximately 12 million Americans enrolled in both Medicare and Medicaid account for a disproportionate share of both programs’ spending while facing substantially greater health, functional and financial challenges than other Medicare beneficiaries, according to two KFF reports published July 15.…

Payer organizations are under pressure to turn talent management from a collection of individual HR programs into a single, coherent strategy, particularly as AI reshapes what skills and leadership look like on the ground. Becker’s asked talent leaders among payers…

Two senators are demanding records from the three largest Medicare Advantage insurers over their use of AI and prior authorization to deny post-acute care to seniors. In July 14 letters to UnitedHealthcare, Humana and CVS Health, Sens. Richard Blumenthal, D-Conn.,…

Elevance Health plans to exit additional Medicaid markets over the next 12 to 18 months where it doesn’t see a viable path forward, executives said July 15 during the company’s second-quarter earnings call. The move follows Elevance’s recent mutual agreement…

Ten providers recently posted job listings seeking leaders in payer contracting and relations. Note: This is not an exhaustive list. Listings were compiled from job-seeker sites. 1. Albany (N.Y.) Med seeks a system payer contracting administrator.  2. Adventist HealthCare, based…

Two more Medicare Advantage insurers are suing CMS over their 2026 star ratings, arguing the agency did not go far enough when it adjusted the ratings following a major court loss to Clover Health earlier this year. SCAN Health Plan…

A federal appeals court has ruled against Alignment Healthcare in its challenge to how CMS calculated the company’s 2025 Medicare Advantage star ratings, upholding a lower court’s decision that mostly sided with the agency. The July 14 ruling caps a…