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Crusader Claims RCM Expert revenue cycle management with same-day human support, transparent pricing, and credentialing included — so you can focus on patients. Maximize revenue.

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Blue Cross Blue Shield Association says hospital AI coding added $942 million in cost over two years for Blue plans, and...
10/09/2026

Blue Cross Blue Shield Association says hospital AI coding added $942 million in cost over two years for Blue plans, and ties AI revenue cycle tools to more than $650 million in extra reimbursement from coding complexity. The American Hospital Association says the report did not review medical records or identify which claims used AI. Complex cases rose from 37 percent in 2023 to 40 percent in late 2025. The AHA says the standard is whether the chart supports the diagnosis.

The American Hospital Association is responding to claims from insurers accusing health systems of improperly coding.

Elevance Health is changing how it pays off-campus hospital services. Hospitals must report the physical location of car...
10/08/2026

Elevance Health is changing how it pays off-campus hospital services. Hospitals must report the physical location of care, and the payer will match that location to hospital addresses before paying the higher hospital rate. Certain off-campus services and lab tests will be paid at the lower off-campus rate. The policies cover commercial, Medicare Advantage, and Medicaid plans and phase in through 2026 and 2027.

Elevance Health is rolling out new billing policies that aim to ensure services are paid for at the appropriate level and drive greater transparency into where patients receive care. | Elevance Health is rolling out new billing policies that aim to ensure services are paid for at the appropriate lev...

Winning a No Surprises Act arbitration case does not deposit the money. Payers have 30 calendar days to pay after a dete...
10/07/2026

Winning a No Surprises Act arbitration case does not deposit the money. Payers have 30 calendar days to pay after a determination, and CMS flagged late or missed payment in an Oct. 1 meeting with all 17 certified IDR entities. The federal process has closed more than 7 million disputes since April 2022, with providers winning about 80 percent. A Sept. 17 appeals ruling left unpaid awards to regulators, so the follow-up work stays in the billing office.

An IDR win isn't a check. Payers have 30 days to pay, courts won't force them to and CMS admits awards are slipping through.

Most practices treat the insurance master like furniture. It has a payer ID. Claims go out. Checks come back. So the pro...
10/06/2026

Most practices treat the insurance master like furniture. It has a payer ID. Claims go out. Checks come back. So the profile must be fine.

It is not always fine.

A Dual SNP set up as commercial insurance will stall the Medicaid secondary. The primary pays. The secondary never gets a usable prior-payer loop. The claim sits.

We wrote up the flag, the fix, and what not to resubmit.

When a Dual SNP is stored as commercial, primary still pays. Medicaid secondary comes back N4. The visit was fine. The payer profile was not.

The Patients Deserve Price Tags Act advanced out of the Senate HELP Committee 21-1 in July, then hit a roadblock on Sept...
10/05/2026

The Patients Deserve Price Tags Act advanced out of the Senate HELP Committee 21-1 in July, then hit a roadblock on Sept. 24 when an expedited vote was blocked. The bill would require upfront negotiated rates, discounted cash prices, and facility fees, and it would extend those rules to labs, imaging centers, and ambulatory surgical centers. Penalties for missing disclosures could reach $5 million, and a separate House bill still differs on key points.

Senate healthcare price transparency legislation could expand hospital reporting, penalties and patient cost disclosures.

The FY 2027 ICD-10-CM code set took effect Oct. 1 and runs through Sept. 30, 2027. It adds 190 codes, deletes 30, and re...
10/02/2026

The FY 2027 ICD-10-CM code set took effect Oct. 1 and runs through Sept. 30, 2027. It adds 190 codes, deletes 30, and revises four. A deleted code left in an EHR favorites list or on a superbill will reject on every claim it touches, and new NCCI edits took effect the same day. Medicare will also deny duplicate lab tests that are not medically necessary.

New ICD-10 codes, NCCI edits and Medicaid eligibility limits all took effect Oct. 1. Here's what practices should check this week.

Practice leaders told MGMA that getting a prior authorization approved does not guarantee the claim will be paid. Member...
10/01/2026

Practice leaders told MGMA that getting a prior authorization approved does not guarantee the claim will be paid. Members described long hold times, delayed decisions, and denials on care that already had an authorization on file. MGMA’s 2026 Regulatory Burden Report found that 90 percent of practices said this work increased over the past year.

Hold times, delayed approvals and denials on authorized care dominated member feedback to MGMA's government affairs team.

CMS has canceled approximately 315000 marketplace enrollments affecting more than 760000 people after identifying unauth...
09/30/2026

CMS has canceled approximately 315000 marketplace enrollments affecting more than 760000 people after identifying unauthorized coverage. Practices are already seeing the impact when patients present cards that no longer match active benefits. Consistent electronic eligibility checks before and at the visit help prevent claims from being submitted against terminated or grace-period coverage.

CMS dropped 760,000 marketplace enrollees in a fraud sweep. Real-time eligibility checks keep the fallout from turning into denials.

UnitedHealthcare, Cigna, and Centene have signed on to CertifyOS shared credentialing. Providers will enter information ...
09/29/2026

UnitedHealthcare, Cigna, and Centene have signed on to CertifyOS shared credentialing. Providers will enter information once through a portal for the participating plans instead of repeating submissions. The program targets lower verification costs and is scheduled to launch this fall.

Three big payers are moving to shared credentialing through CertifyOS. What it could fix for practices and what it leaves on your desk.

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