Revenue Cycle and Payer News – June 25, 2025

Altera Digital Health Collaborates with MCAG Amid $2.8B Blue Cross Blue Shield Provider Settlement
Altera Digital Health, a global healthcare IT leader, announced it has entered into an agreement with Managed Care Advisory Group, Inc. (MCAG), one of the largest revenue recovery consulting firms, to bring MCAG’s class action lawsuit recovery services to hospitals and providers. MCAG will help eligible healthcare parties navigate the claims filing process and recover funds from class action lawsuit settlements, including the $2.8 billion Blue Cross Blue Shield (BCBS) provider settlement. Eligible healthcare providers will be required to enter into an agreement with MCAG (which includes a contingent fee) to obtain this service.

Anthem Blue Cross and Blue Shield, Boone Health Announce New Four-Year Contract Agreement
Anthem Blue Cross and Blue Shield in Missouri (Anthem) and Boone Health are pleased to announce a new four-year agreement that ensures continued in-network access to Boone Health’s hospitals, clinics, and providers for all Anthem members, including those enrolled in employer-sponsored and Medicare Advantage health plans.

Redefining TRICARE: CareSource Military & Veterans provides choice, simplicity and care that delivers
During TRICARE’s 2025 Open Season, approximately 146,000 eligible beneficiaries in Tampa, Florida and Atlanta, Georgia–including active-duty family members, survivors, military retirees and their families–can now choose CareSource Military & Veterans as their health plan through the TRICARE Prime® Demo by CareSource Military & Veterans™. This health plan is designed to enhance health care access and prioritize the unique needs of the military community.

Independence Blue Cross and Children’s Hospital of Philadelphia sign new agreement that reflects their joint commitment to children’s health in the region
Independence Blue Cross (IBX) and Children’s Hospital of Philadelphia (CHOP) have signed a new, multi-year agreement, which will be effective July 1, 2025. The agreement ensures that families in the region with IBX health plans can access high-quality pediatric care at CHOP. It also strengthens IBX and CHOP’s existing collaboration, reflecting a shared commitment between the two organizations to improve children’s health in Philadelphia and the surrounding region.

Health Plans Take Action to Simplify Prior Authorization
Health insurance plans announced a series of commitments to streamline, simplify and reduce prior authorization – a critical safeguard to ensure their members’ care is safe, effective, evidence-based and affordable. Building on health plans’ existing efforts, these new actions are focused on connecting patients more quickly to the care they need while minimizing administrative burdens on providers.

Humana Launches “Invite” Campaign to Inspire Active Aging Through Pickleball and Community Connection
Humana Inc., a health and well-being company, is expanding its commitment to senior wellness with the launch of Invite, a new campaign designed to encourage older adults of all fitness levels to stay active, connected and engaged – starting with the fastest-growing sport in America: pickleball.

Aetna supports industry actions to simplify prior authorization
Aetna®, a CVS Health® company, announced its support of initiatives championed by American’s Health Insurance Plans to improve the experience of doctors and patients. Aetna is also committed to leading the market through a comprehensive strategy to make it easier to navigate health care — reducing reviews, simplifying care site transitions and putting technology to work for health care professionals and their patients.

Cigna Healthcare Unveils Industry-Leading AI-Powered Digital Tools for a Simple and Reliable Customer Experience
Cigna Healthcare, the health benefits division of The Cigna Group, is introducing a series of new digital features to improve the customer experience during common health insurance interactions, such as checking benefits coverage, estimating costs and finding care. These enhancements are designed to provide a reliably simple experience for everyday needs and are an important step in delivering on the company’s commitment to make health care easier for customers.

Independence Blue Cross introduces Generative AI Tool
Independence Blue Cross (IBX) recently launched a cutting-edge generative AI (GenAI) tool designed to augment IBX customer service interactions. This innovative solution empowers customer service representatives to deliver faster, more accurate responses to members and providers in real time.

Humana Expands Science-Based Targets with New SBTi-Validated Target
Humana Inc. announced the expansion of its validated science-based target (SBT) with recent approval of a new financial institution target by the Science Based Targets initiative (SBTi). This milestone highlights Humana’s dedication to sustainability, reinforcing its commitment to improving health and well-being while aiming for significant emissions reductions across the company’s value chain.

Independence Blue Cross’s expanded behavioral health services deliver faster care, improved health outcomes, and reduced costs
Independence Blue Cross (IBX) is closing critical gaps in care and delivering impactful results with its expanded behavioral health services (which include services for both mental health and substance use disorder).

For Americans, Every Day Is Independence Day When It Comes to Their Health by Humana – Americans are signaling a shift in what it means to live a fulfilling life, with many preferring independence over longevity without self-sufficiency. While seniors, in particular, maintain an optimistic outlook on aging, they face significant challenges as they grow older, including financial strain, anxiety about future mental health and persistent negative cultural attitudes toward aging.

How clinical decision support tools can help redefine patient care by UnitedHealth Group – Health care continues to shift toward a value-based care model, where providers focus on preventative care, quality and outcomes. Notably, CMS aims to have all Medicare fee-for-service beneficiaries and the vast majority of Medicaid beneficiaries in value-based care relationships by 2030.

AHIP / Kyruus Health
When: Thursday, June 26, 2025  1:00 pm ET
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The 2025 Employer Acquisition Playbook: Strategies for Health Plan Success – Employers today are making decisions based on evolving expectations around digital experiences, cost-effectiveness, and employee satisfaction. Many health insurance plans struggle to differentiate themselves and communicate their value effectively to these employer groups. The webinar will tackle the challenges plans face in acquiring and retaining employer groups in a highly competitive market.

AHIP / Optum
When: Tuesday, July 29, 2025  1:00 pm ET
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Join this session to discover how to streamline the medical review process for Medicare beneficiaries while ensuring adherence to the latest CMS regulations. We’ll provide an overview of Medicare Content Navigator and InterQual® Transparency, which are designed to help you align with the Medicare Advantage final rule (CMS-4201-F). You’ll also get an exclusive sneak peek of the InterQual team’s product development initiatives that will support compliance with the CMS Interoperability and Prior Authorization final rule (CMS-0057-F), effective January 1, 2026.

AHIP / ProviderTrust
When: Tuesday, August 12, 2025  12:00 pm ET
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This webinar will unpack the key areas where credentialing processes will need to change, offering digestible explanations and concrete ways to meet the new guidelines. After we diving deeper into the guidelines, we’ll wrap up with a high-level view of DynamicNPI, our data-forward solution designed to help payers easily meet and exceed the NCQA guidelines while improving the quality of their provider data.