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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 -
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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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 -
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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 -
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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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