New & Notable
UnitedHealthcare eliminates prior authorization for rural providers
In addition to scrapping prior authorization, UnitedHealthcare said it will speed up payments and create more community-based care models for rural providers.
Mental health parity remains elusive in 43 states
In-network mental healthcare is harder to get in most states than physical healthcare, potentially due to disparate provider reimbursement rates.
Payers face faster prior authorization approvals under CMS proposal
Under the proposed rule, affected payers would need to respond to urgent prior authorization requests for drugs within 24 hours and to standard requests within 72 hours.
Digital member experience improves for health plans, gaps remain
A recent JD Power survey showed that, although the digital member experience is improving for health plans, there's room to grow for onboarding and patient education.
CMS finalizes Medicare Advantage star ratings overhaul, sending billions of dollars more to insurers
— Healthcare DiveSponsored Sites
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Revenue Cycle Management
Greenway Health
Improving healthcare through innovation is at the heart of Greenway Health’s work. We provide electronic health records (EHR), practice management, and revenue cycle management solutions that help practices in multiple specialties grow profitably, remain compliant, work more efficiently, and improve patient outcomes.
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Interoperability
Veradigm Network to Payer
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Risk Adjustment Compliance
RAAPID
RAAPID develops AI-powered risk adjustment solutions for healthcare payers, providers, and supporting organizations. The company's HITRUST-certified platform uses Neuro-Symbolic AI to identify chronic conditions, determine HCC codes, and provide explainable documentation for complete audit defense. Backed by M12 (Microsoft's venture fund), RAAPID serves organizations participating in Medicare Advantage, ACA, Medicare ACO, and Medicaid programs with both retrospective and prospective risk capture capabilities. Founded by healthcare technology veterans with over 20 years of experience, RAAPID is headquartered in Louisville, Kentucky.
Healthcare Strategies: A Podcast
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A podcast for healthcare professionals seeking solutions to today's and tomorrow's top challenges. Hosted by the editors of Xtelligent Healthcare Media, this podcast series focuses on real-world use cases that are leading to tangible improvements in care quality, outcomes, and cost.
Guests from leading provider, payer, government, and other organizations share their approaches to transforming healthcare in a meaningful and lasting way.
View All Episodes
Latest News
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After ACA subsidy lapse, consumers opt for low-cost Marketplace plans
The number of patients selecting low-cost, high-deductible ACA marketplace plans rose from 30% to 40% for the 2026 Open Enrollment Period.
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UnitedHealthcare launches AI chatbot for member care navigation
UnitedHealthcare said the AI chatbot will support customer advocates by handling simple care navigation tasks and referring members to advocates when needed.
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CMS introduces value-based pediatric model for Medicaid
The new ASPIRE model will award five state Medicaid agencies with $125M to coordinate the care for children with complex medical and behavioral needs.
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High costs, more uninsured without enhanced premium tax credits
A new KFF survey reveals significantly higher costs following the expiration of enhanced subsidies for Marketplace plans, with more enrollees dropping coverage this year.
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UnitedHealthcare expands doula benefit to support maternal health
UnitedHealthcare will expand its doula benefit to certain employer-sponsored health plans as part of the payer's strategy to improve maternal health outcomes.
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Aetna to pay $117.7M to settle Medicare Advantage false claims case
The Department of Justice said Aetna submitted inaccurate diagnosis codes to untruthfully inflate its risk pool.
Features
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5 healthcare pros on the trends defining primary care
The 2025 Payer + Provider Virtual Summit explored AI, value-based care and community-based partnerships, offering strategies on how to promote primary and preventive care.
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How payers can regain consumer trust via personalized care
Creating personalized health plans is central to regaining consumer trust. To do that, payers must outline safeguards for member data and create seamless experiences.
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With trust low and costs high, do payers stand to lose members?
Healthcare payers might see fewer enrollments as members face higher prices for a product they don't trust or see as high value.
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Breaking down the ABCs of rising alternative health plans
More employers are seeking alternative health plans, like AHPs and ICHRAs, to bend the cost curve, but education is key to navigating their growing popularity.