It is no secret that prior authorization has long been a sore subject between payers and providers. In June 2025, insurers committed to easing prior authorization requirements. Now, AHIP (formerly ...

As administrative costs rise and reimbursement grows more complex, both health plans and providers are under increasing pressure to improve the payment experience. Faster payment remains important, ...

Arkansas will begin a soft launch of Medicaid work and community engagement requirements for enrollees in its Medicaid expansion program on July 1, with full enforcement set to begin Jan. 1, 2027.

Blue Shield of California officials attended an April 8 hearing with the San Francisco Board of Supervisors regarding care denials for workers. The hearing followed reporting from the NBC Bay Area ...

Virginia Democratic Gov. Abigail Spanberger signed HB736 into law April 6, furthering prior authorization reform in the state. Effective in 2027, the law establishes a minimum duration requirement.

Nebraska will roll out Medicaid work requirements in May, making it the first expansion state to implement these provisions under HR 1. Here are four notes leading up to Nebraska’s launch: 1. Medicaid ...

Blue Cross Blue Shield plans faced widespread financial pressure in 2025, with several major insurers posting operating losses as medical and pharmacy costs continue to climb. The struggles played out ...

AP of South Florida, a Florida-based insurance brokerage, has agreed to plead guilty to one count of major fraud against the U.S. for its role in a fraudulent ACA enrollment scheme. In a parallel ...

At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory ...

CMS has issued operational guidance to states regarding how to implement H.R. 1’s Medicaid coverage restrictions for noncitizens, which take effect Oct. 1. On April 8, the agency outlined how states ...

Thirty-six percent of providers believe payers reliably deliver on promises, according to an inaugural Aetna provider survey released April 8. The survey will run quarterly, polling representatives of ...