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ROANOKE, Va.--(BUSINESS WIRE)--Anthem Blue Cross and Blue Shield in Virginia and Carilion Clinic announced today that they have reached a new three-year agreement that will maintain access to Carilion physicians and facilities for Anthem members across Western Virginia, strengthening the organizations' collaboration around access, quality, affordability, and better health outcomes. The agreement reflects a shared commitment to ensuring patients, families, employers, and the communities they ser...

SAN FRANCISCO--(BUSINESS WIRE)--Bartko Pavia Secures Landmark Ruling by Judge Chatterjee on Standard of Review in Antitrust Cases; Will Shape Future Healthcare Antitrust Litigation...

SCHERTZ, Texas--(BUSINESS WIRE)--Nexus Medical Enterprises, LLC, a national leader in clinical and specialty review services, is proud to announce the promotion of Aaron Black to Senior Vice President of Clinical & Administrative Operations.In this executive leadership role, Black will serve as a vital bridge between Nexus’s clinical and administrative operations, helping ensure client expectations are exceeded while continuing to advance the organization’s focus on quality, compliance and o...

WEST HILLS, Calif.--(BUSINESS WIRE)--Peyton AI® today launched an AI-powered triage platform for medical negligence claims, built to help law firms, malpractice insurers and hospital risk teams learn in minutes whether a case merits further investment, a call that typically takes months of record review and an initial expert report. In a validation study of more than 1,000 closed cases, the company’s Merit Score™ engine produced zero recorded hallucinations: no fabricated citations, case refere...

MADISON, Wis.--(BUSINESS WIRE)--Clarventa announced TrueNet, a prescription drug program that focuses on upfront discounts for the costliest medications, delivering greater value....

SALT LAKE CITY--(BUSINESS WIRE)--Cotiviti, The Healthcare Infrastructure Company™, today announced new capabilities that help health plans identify care gaps sooner, coordinate outreach across programs and act before opportunities are missed. As health plans prepare for the shift to digital quality measurement led by the National Committee for Quality Assurance (NCQA), the ability to identify and act on quality opportunities earlier is becoming increasingly important. Cotiviti's new Concurrent...

LEE’S SUMMIT, Mo.--(BUSINESS WIRE)--Government Employees Health Association, Inc. (G.E.H.A), a nonprofit member association serving the federal community, has announced that premiums will remain flat or decrease for six of its seven health options for the 2027 plan year, reinforcing G.E.H.A’s focus on affordability as federal families continue to navigate rising everyday costs.G.E.H.A will offer five Federal Employees Health Benefits Program (FEHB) options in 2027: a High Deductible Health Plan...

CONSHOHOCKEN, Pa.--(BUSINESS WIRE)--PharmaForce today announced its 340B Rebate and Maximum Fair Price (MFP) solution, giving covered entities a single connected workflow to identify eligible claims, submit them, and track outcomes through payment reconciliation. Because the solution is built into the platform that already determines 340B eligibility, PharmaForce is the source of truth on each claim, rather than a bolt-on layer that requires handing data to a third party for a separate determin...

PITTSBURGH--(BUSINESS WIRE)--Mark Farrah Associates presented the latest year-over-year enrollment trends, comparing 2nd quarter 2026 with 2nd quarter 2025 segment membership....

PHILADELPHIA--(BUSINESS WIRE)--Medicaid-focused plans’ per member Core administrative costs grew by 5.6% in 2025 versus 5.0% in 2024, holding product mix constant. This was the fastest growth since 2020. Growth in costs for the cluster of Account and Membership Administration, at 6.8%, was the fastest growth for that cluster since 2019. Median PMPM costs for all products for all reporting Plans were $55.37 PMPM versus $52.40 PMPM last year. At 8.1% of premium equivalents, health plan administra...