Healthcare Payers

No Surprises Act Prevented 10M Surprise Medical Bills, But IDR Use Grows

January 30, 2024 - The No Surprises Act (NSA) helped prevent 10.1 million surprise medical bills in the first nine months of 2023, according to a survey from AHIP and the Blue Cross Blue Shield Association (BCBSA). The No Surprises Act took effect on January 1, 2022, for those enrolled in commercial health insurance or group health plans. The law states that when...


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UnitedHealth Group Saw Revenue and Enrollment Growth in 2023

by Victoria Bailey

UnitedHealth Group saw revenue growth of over 14 percent in 2023, while adding 1.7 million new consumers to its Medicare and commercial offerings, executives shared during the UnitedHealth Group Fourth...

CMS Finalizes Payer Requirements to Streamline Prior Authorization

by Victoria Bailey

CMS has finalized requirements for payers to streamline the prior authorization process and improve the electronic exchange of health information to help limit patient care disruptions. The CMS...

Payers Embrace Healthcare IT for Cost Optimization, Member Engagement

by Victoria Bailey

Payers are investing in healthcare IT resources to support cost optimization and improve member experience, according to a study from EY-Parthenon and KLAS Research. As payers face operational and...

How Public, Private Payers Cover Care for the LGBTQ+ Population

by Victoria Bailey

In a country with rampant health disparities, health insurance coverage can be the difference between accessing necessary services and going without care. How health plans cover care for socially disadvantaged and vulnerable populations...

Study Finds Geographic Variation in Payer Prices for Office Visits

by Victoria Bailey

Among a single health insurer, prices for office visits varied by geographic location, with the upper-Midwest and Southeast regions seeing higher costs, a study published in JAMA Health Forum...

4 Key Strategies to Promote Effective Payer, Provider Alignment

by Victoria Bailey

Strong payer-provider alignment makes life easier for all healthcare stakeholders. While providers administer services to individuals, payers are responsible for reimbursing providers and ensuring members have coverage for their care....

Cigna Healthcare Invests $1M to Reduce Food Insecurity for Seniors

by Victoria Bailey

Cigna’s health benefits provider, Cigna Healthcare, will invest $1 million in community-based organizations to address food insecurity among older adults. “Too many people in our country,...

Exploring the History of the Blue Cross Blue Shield Association

by Victoria Bailey

Blue Cross Blue Shield is an easily recognizable name in the healthcare industry, but just how many health plans fall under this organization and what are the differences between them? In the following article, HealthPayerIntelligence...

How Quality Measures, Star Ratings Impact Healthcare Payers

by Editorial Staff

Quality performance metrics such as HEDIS, Medicare Advantage Star Ratings, and standardized core quality measures can give consumers an indication of healthcare payer quality. Standardized quality...

Cigna Removes Prior Authorization for 25% of Medical Services

by Victoria Bailey

Cigna Healthcare is removing prior authorization requirements for nearly 25 percent of medical services, facilitating access to care for members. The Cigna Group’s health benefits provider...

Top 5 Largest Health Insurance Payers in the United States

by Editorial Staff

The Affordable Care Act (ACA) and Medicare Advantage plans continue to bolster enrollment for major payers. Enhanced premium subsidies on the ACA market along with greater federal investments in...

KLAS: Payers Want Efficient Claims and Administration Platforms

by Victoria Bailey

Payers prefer to utilize claims and administration platforms from vendors that are efficient, manage multiple business lines, and can meet their complex needs, according to a KLAS report. The Payer...

How Payers Are Reducing Prior Authorizations, Limiting Care Disruptions

by Victoria Bailey

Although prior authorization aims to control costs and limit unnecessary medical procedures, healthcare stakeholders have continued to raise concerns that the process creates substantial administrative...

Unpacking What Price Transparency Looks Like for Health Plans

by Victoria Bailey

Consumers are struggling to understand and afford healthcare in the United States. A new federal requirement aimed at increasing healthcare price transparency aims to help, but payers can also use this newly available information to their...

ACA Marketplace Premiums Set to Rise Again, Inflation a Key Factor

by Sarai Rodriguez

Even as inflation seems to be plunging from its peak, the ongoing pressure from high medical costs is set to push ACA Marketplace premiums up to an average of 6 percent in 2024, according to...

Biden Admin Proposes Mental Health Parity in Private Health Plans

by Victoria Bailey

The Biden-Harris Administration has proposed a rule to improve access to mental healthcare for privately insured Americans by establishing mental health parity requirements. The rule supports the...

UHC Reports 13% Revenue Growth in Q2 2023 Due to Rising Enrollment

by Kelsey Waddill

UnitedHealth Group’s earnings call for the second quarter of 2023 featured revenue growth due to strong performance from the healthcare company’s insurance arm, UnitedHealthcare, and its...

How Payers Can Identify Providers for High-Performing Networks

by Victoria Bailey

Enrolling in the right health plan can significantly influence healthcare costs and consumer health outcomes. Despite significant healthcare spending, the United States has the worst health outcomes among high-income countries. In 2021,...