Nebraska employers lead the nation in self-funded healthcare benefits, with 73% of the state’s employer-sponsored insurance structured under ERISA rather than purchased from an insurer, according to ...

CMS is proposing to create a new payment pathway for algorithm-driven diagnostic software, including AI tools, as part of its 2027 Hospital Outpatient Prospective Payment System and Ambulatory Surgery ...

Centene’s Ambetter is exiting Arkansas’ Medicaid expansion program, Arkansas Health and Opportunity for Me, in 2027. In a July 6 statement to Becker’s, the company attributed the decision to “current ...

Nearly 97% of UnitedHealth’s in-home Medicare Advantage diagnoses were supported by a patient’s medical record in 2025, according to a review commissioned by the company. The findings are the latest ...

Blue Cross and Blue Shield of Louisiana has lost its most recent bid challenging how CMS calculated its 2025 Medicare Advantage star rating. On June 26, the U.S. Court of Appeals for the D.C. Circuit ...

John Prince, who spent nearly two decades in executive roles at Optum before moving into healthcare private equity, died June 28. He was 59. Mr. Prince died in Vero Beach, Fla., after a battle with ...

“Payvider” — a portmanteau of “payer” and “provider” — commonly refers to healthcare organizations that have both care and insurance capabilities. Think: provider-sponsored health plans and ...

Nearly 5,000 independent pharmacies have filed a federal lawsuit against Prime Therapeutics, alleging the pharmacy benefit manager conspired with Cigna’s Express Scripts to suppress pharmacy ...

Eight insurers have announced they will stop offering individual ACA marketplace plans, either nationally or in specific states, after the 2026 plan year. The withdrawals come amid declining ...

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 ...

Learn more about the "4th Annual – Fall Payer Issues Roundtable" event.

From regional plans to large, for-profit health insurers, 2026 has marked a year of executive transition. Here are 18 C-suite executives who recently shared plans to leave their organization: 1. Mike ...