Thursday, April 9, 2026

Sources: Becker's Payer Issues, KFF Health News, WCH Insights — March 31–April 8, 2026

The March 31 CMS-0057-F deadline put payer prior auth data online for the first time. Now that payer-specific numbers are being analyzed:

- Centene Medicare Advantage: 93.6% of appealed denials overturned - Oscar ACA plans: 25.3% denial rate - UHC: dropped from 33% to 20% denial rate the year Congress started holding hearings - Overall MA: 80% of appealed denials overturned, per KFF - Physicians now file 39 prior auth requests per week, consuming 13 hours of staff time - Data gap: no service-level breakdown, no denial reasons, no Rx data. KFF called it "offers little insight."

Sources: Becker's Payer Issues, Insurance News Net, Distilinfo — March 9–April 2026

A Minnesota federal judge ordered UnitedHealth to produce internal documents on its nH Predict AI algorithm by April 29. The algorithm allegedly overrode physicians' clinical judgments for elderly Medicare Advantage patients in post-acute care, then denied coverage. Plaintiffs allege a 90% error rate — nine out of ten denials reversed on appeal.

Documents to be produced by April 29: - All nH Predict analysis and design records (back to January 2017) - Records on whether the algorithm was designed to override clinical judgment - Compensation records for post-acute medical directors who approved denials - Government investigation records - Internal AI review board membership

Sources: PR Newswire, Modern Healthcare, Fierce Healthcare — March 24–26, 2026

OpenEvidence ($12B valuation post-$250M raise in January) launched Coding Intelligence, an AI feature that auto-generates ICD-10 diagnoses, E/M level recommendations, and CPT code suggestions from clinical notes at the end of each patient visit. Applies CMS Correct Coding Initiative rules before surfacing suggestions. Free for all verified clinicians.

Key distinctions from Altair: - Physician-facing, not biller-facing. Code suggestion happens at point of care, not at the billing desk. - Does not touch denial management, policy retrieval, or prior auth. - No claim scoring or denial memory capability.

An advocacy ad campaign launched April 7 features patients hit with surprise bills after hospitals refused to give upfront prices:

- Mark Thompson (NM): Got a $3,587 estimate for outpatient surgery. Received bills totaling $160,000. - Kerry Schrader (AL): Asked for a biopsy price. Got a $28,000 bill. - Robin Wayman (TN): Told her surgery would cost $4,000. Got an $80,000 bill.

The campaign pushes the bipartisan "Patients Deserve Price Tags Act," which would codify Trump's 2025 executive order on healthcare price transparency.

Sources: S&P Global, Modern Healthcare, Becker's — 2025 SEC proxy filings

Six major health insurance CEOs split $159.4 million in total compensation in 2024:

- UnitedHealth CEO Andrew Witty: $26.4M (348:1 CEO-to-worker pay ratio) - Cigna CEO David Cordani: $23.3M (279:1 ratio) - CVS/Aetna CEO Karen Lynch: ~$28M - Elevance CEO Gail Boudreaux: ~$21M

In the same period, their plans collectively denied 17–25% of in-network claims. National Nurses United documented that higher denial rates correlate with higher CEO compensation under current performance metric structures — because denial rates reduce claims paid, improving the combined ratio, which drives executive bonuses.