Priority Health is estimated to have collected at least $4.4 million in Medicare Advantage overpayments throughout 2018 and 2019, according to a March audit from the HHS Office of the Inspector ...

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 ...

The day after CMS released its final 2027 Medicare Advantage and Part D payment rule, Chris Klomp, director of Medicare and deputy administrator at the agency, sat down with Health Tech Nerds Radio ...

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 ...

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 ...

In early February, Republican lawmakers in Oklahoma introduced a state bill and joint resolution that could shake up the future of Medicaid expansion. The April 6 version of HB 4440 poses a state ...

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.

Washington, D.C. has the highest average monthly premium for ACA enrollees who received advance premium tax credits in 2026, while Texas has the lowest, according to a KFF analysis. After enhanced ...

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 ...

In 2024, the uninsured rate grew for the first time since 2019, according to an April 9 KFF issue brief. KFF reviewed data on uninsured trends and demographics in recent years, focusing on individuals ...

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.