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Counsel Health via Google Gemini
Sponsored by Counsel Health3 questions every payer should ask about medical AI
As medical AI scales, how are payers ensuring safe and compliant care?
April 20, 2026 -
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Stakeholders urge Labor Department to finalize PBM transparency rule
Employers, lawmakers and more said regulators should hustle to get disclosure mandates for the controversial drug middlemen across the finish line, while PBMs slammed the rule as illegal, unnecessary and anticompetitive.
By Rebecca Pifer Parduhn • April 17, 2026 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
TrendlinePayer/provider relationships
As M&A intensifies and companies embrace more holistic and value-based care models, partnerships have become more closely intertwined.
By Healthcare Dive staff -
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More employers considering medical, pharmacy vendor switch amid rising healthcare costs, survey finds
Healthcare affordability continues to keep employers up at night. More businesses are shopping for new healthcare vendors as a result, according to the Purchaser Business Group on Health.
By Rebecca Pifer Parduhn • April 16, 2026 -
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ACA exchanges will continue to shrink as fewer enrollees pay premiums, analysis suggests
About 14% of ACA enrollees didn’t pay premiums in January, a higher rate than usual and one that suggests ACA enrollment will continue to decline, according to Wakely.
By Rebecca Pifer Parduhn • April 16, 2026 -
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More insurance claims denials are being overturned upon appeal, study finds
Study authors, who reviewed data from New York, said rising rates of overturned claims suggest that insurers’ claims review processes might not be working as intended, and policymakers should consider getting involved.
By Rebecca Pifer Parduhn • April 15, 2026 -
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CMS accepts more than 150 providers, digital health firms for ACCESS model
Participants will receive set reimbursement for managing Medicare beneficiaries’ chronic conditions, like diabetes, chronic kidney disease and hypertension.
By Emily Olsen • April 14, 2026 -
Alamy
Surprise BillingCalifornia judge tosses Elevance’s surprise billing suit in win for providers
It’s a major victory for controversial billing intermediary HaloMD, which cheered the court’s decision. Elevance said it plans to appeal.
By Rebecca Pifer Parduhn • April 14, 2026 -
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Medicare proposes 2.4% pay bump for inpatient hospitals in 2027, floats mandatory model
Regulators are proposing to send $1.4 billion more to acute care hospitals and debut the first nationwide, mandatory payment model to lower the cost of joint replacements. Hospitals pushed back.
By Sydney Halleman • April 13, 2026 -
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CMS proposes new deadlines for prior authorizations for drugs
Drugs were left out of a 2024 rule streamlining prior authorizations by making decisions electronic and requiring payers to turn them around more quickly. The Trump administration is looking to address that gap.
By Rebecca Pifer Parduhn • April 13, 2026 -
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Sponsored by PointClickCareFrom afterthought to advantage: How health plans are rethinking post-acute care
From reactive to proactive, how plans are transforming post-acute care management.
April 13, 2026 -
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ICHRAs, a growth opportunity for insurers, face uphill battle
Employers are turning to Individual Coverage Health Reimbursement Arrangements to cut costs, but rising premiums and instability on the individual market pose challenges.
By Michael Brady • April 8, 2026 -
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Jefferson Health sues Aetna over Medicare Advantage ‘downcoding’ policy
The health system claims the policy, which reduces reimbursement for some inpatient hospital stays, violates federal law and its reimbursement contract with Aetna. The insurer disagreed with Jefferson’s allegations.
By Sydney Halleman • April 8, 2026 -
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CMS finalizes higher Medicare Advantage rates for 2027 in gift to insurers
Regulators locked in a 2.48% rate hike for next year, much higher than the 0.09% that was proposed. Analysts said the Trump administration was likely spooked about coverage disruptions for seniors before the midterm elections.
By Rebecca Pifer Parduhn • April 7, 2026 -
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Insurers committed to cutting prior authorizations have eliminated 11% so far
Last summer, major payers committed to pare back onerous prior authorization policies, to the skepticism of providers. Now, AHIP and the Blue Cross Blue Shield Association are providing an update on insurers’ progress.
By Rebecca Pifer Parduhn • April 7, 2026 -
Permission granted by CVS Caremark
Sponsored by CVS CaremarkStanding up to rising prescription drug costs increases access to breakthrough medications
For millions of Americans, accessing the medications they need at prices they can afford has gotten increasingly difficult.
By Dr. Michelle Gourdine, Senior Vice President, CVS Health; Chief Medical Officer, CVS Caremark • April 7, 2026 -
Alamy
Centene creates two new executive leadership roles
It’s the latest in a flurry of executive appointments from health insurers looking to strengthen their leadership teams amid regulatory headwinds and elevated medical costs.
By Rebecca Pifer Parduhn • April 6, 2026 -
Kayla Bartkowski via Getty Images
CMS finalizes Medicare Advantage star ratings overhaul, sending billions of dollars more to insurers
Regulators cut almost a dozen metrics that factor into the quality ratings and reverted back to an older and more generous bonus system. MA plans will get more than $18 billion in additional payments over the next decade as a result.
By Rebecca Pifer Parduhn • April 3, 2026 -
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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 -
Kayla Bartkowski via Getty Images
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 -
Envato/monkeybusiness
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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