Payer
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Bipartisan lawmakers urge CMS to crack down on Medicare Advantage overpayments
Senators praised a recent CMS proposal aimed at reducing payments in MA, but urged the agency to work with Congress and go further.
By Emily Olsen • April 1, 2026 -
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Elevance sidesteps Medicare Advantage sanctions for now
The insurer had until the end of March to correct faulty data submissions or be hit with severe sanctions from the CMS. But regulators agreed to give Elevance more time to comply.
By Rebecca Pifer Parduhn • April 1, 2026 -
Permission granted by Elevance Health
Elevance fills slew of mid-level leadership positions
The company has been overhauling its executive bench as it attempts to bolster flagging insurance profits and capitalize on growth in Carelon, including through six new appointments on Tuesday.
By Rebecca Pifer Parduhn • March 31, 2026 -
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Tech nonprofit sues CMS over Medicare AI prior authorization pilot
The Electronic Frontier Foundation is seeking more information on the government’s agreements with participating vendors, along with records related to any evaluations on accuracy, bias or hallucinations in their technology.
By Emily Olsen • March 30, 2026 -
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ACA premium spike funnels more consumers into high-deductible plans: CMS
Average premiums for ACA plans increased 58% this year after more generous financial assistance expired, while enrollment in low-premium, high-deductible bronze plans jumped, according to new federal data.
By Rebecca Pifer Parduhn • March 30, 2026 -
Mario Tama / Staff via Getty Images
OpinionRestoring balance to the No Surprises Act
In response to an opinion piece from the American Hospital Association, Dr. Catherine Gaffigan, president of health solutions at Elevance, defends the company’s new facility administrative policy.
By Catherine Gaffigan • March 30, 2026 -
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Sponsored by AMPSWinning the arms race between billing complexity and payment accuracy
High-dollar claims are the new baseline. Is your payment integrity strategy built to keep up?
By Jonathan Jeffress, Chief Operating Officer, AMPS • March 30, 2026 -
Permission granted by RAAPID INC
Sponsored by RAAPID INCBeyond accuracy: What “defensible coding” really means under today’s RADV scrutiny
RADV scrutiny has moved from checking codes to investigating the processes that produce them.
By Wynda Clayton, Director of Risk Adjustment Coding & Compliance, RAAPID • March 30, 2026 -
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Justice Department sues NewYork-Presbyterian in second hospital antitrust case this year
Federal regulators accused the health system of using its market power to force insurers into “all-or-nothing” contracts. The Justice Department filed a similar lawsuit against OhioHealth in February.
By Sydney Halleman • March 27, 2026 -
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10M could lose Medicaid due to work requirements, more frequent eligibility checks: study
Between 5 million and 10 million people could be disenrolled due to cuts to the safety-net insurance program, depending on states’ mitigation strategies, according to the analysis.
By Emily Olsen • March 27, 2026 -
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OpinionKeep care accessible and affordable for patients
Rick Pollack, president and CEO of the American Hospital Association, argues a new policy from Anthem creates an “impossible” mandate for independent physicians and hospitals.
By Rick Pollack • March 26, 2026 -
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House Democrats accuse CMS official of misleading Congress under oath
CMS Deputy Administrator Kimberly Brandt told Congress that the CMS couldn’t meet with Minnesota before cutting off Medicaid funding because of litigation. Democrats say her testimony made no sense.
By Rebecca Pifer Parduhn • March 26, 2026 -
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Cigna Healthcare names new chief medical officer
Dr. Stanley Crittenden will take up the post at Cigna’s health benefits division months after his predecessor became CMO of the entire organization.
By Emily Olsen • March 25, 2026 -
Courtesy of UnitedHealth Group
Faith-based investor coalition sues UnitedHealth to force disclosure of M&A impacts
The shareholders, members of the Interfaith Center on Corporate Responsibility, have been trying to get the healthcare juggernaut to share more information about its controversial business practices for more than a year.
By Rebecca Pifer Parduhn • March 25, 2026 -
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CVS, FTC reach proposed settlement in insulin pricing case
A settlement between CVS' pharmacy benefit manager and antitrust regulators would leave UnitedHealth as the sole holdout in high-profile suit.
By Rebecca Pifer Parduhn • March 24, 2026 -
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CommonSpirit, Humana reach new nationwide Medicare Advantage contract
The new agreement will give Humana’s MA members access to CommonSpirit’s doctors and facilities for the next three years, and returns CommonSpirit to Humana’s networks in Colorado and Texas.
By Rebecca Pifer Parduhn • March 24, 2026 -
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CMS sets standards for electronic transfer of claims documentation
The rule standardizes the electronic exchange of medical records and other documents requested by payers to support claims. It should cut out outdated methods like faxes and snail mail, the CMS said.
By Emily Olsen • March 23, 2026 -
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1 in 10 ACA enrollees dropped coverage after subsidy lapse: poll
More than half of respondents said their healthcare expenses are “a lot higher” this year, according to the KFF survey. One in 10 reported dropping coverage and becoming uninsured.
By Emily Olsen • March 23, 2026 -
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Sponsored by PointClickCareThe post-acute blind spot: Why what happens after discharge matters more than ever
Post-acute care is healthcare’s biggest blind spot — and a major opportunity.
March 23, 2026 -
Providence considering sale of health plan
The Catholic nonprofit continues to search for new ways to cut costs, including a potential sale of Providence Health Plan, the company disclosed Thursday.
By Rebecca Pifer Parduhn • March 20, 2026 -
Permission granted by Alignment
Q&AAlignment Healthcare’s idiosyncratic take on Medicare Advantage
Other MA plans are downsizing, upset about coding changes and lobbying for higher rates. Alignment is growing and unbothered by the policy and payment fuss. CEO John Kao lays out how his company is breaking away from the pack.
By Rebecca Pifer Parduhn • March 18, 2026 -
Emily Olsen/Healthcare Dive
Deep Dive // HIMSS26Balancing AI innovation and risk: 5 takeaways from HIMSS26
The healthcare sector will increasingly adopt autonomous agents this year, but it’ll have to consider how to adapt governance structures and manage cybersecurity risks as AI evolves, experts said in Las Vegas last week.
By Emily Olsen and Jill Hughes • March 16, 2026 -
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HIMSS26CMS wants seniors to use AI for care navigation
The agency plans to introduce AI agents to help Medicare beneficiaries find doctors and health plans, a challenge given many enrollees don’t yet trust the tools, CMS Administrator Dr. Mehmet Oz said during the HIMSS conference.
By Emily Olsen • March 13, 2026 -
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HIMSS26Safety-net providers tackle AI adoption as Medicaid cuts loom
Artificial intelligence tools could help safety-net organizations close gaps created by massive cuts to Medicaid signed into law last year, experts said at the HIMSS conference.
By Emily Olsen • March 12, 2026 -
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CVS to pay $118M to settle Medicare Advantage fraud allegations
The settlement announced by the Department of Justice on Wednesday comes after federal regulators accused Aetna of submitting inaccurate data to the CMS.
By Rebecca Pifer Parduhn • March 11, 2026
