Every health plan and every provider network has a credentialing function. Not every health plan and every network has a credentialing *system* — and the difference between those two things is where most of the downstream pain in this industry comes from. Credentialing is the gate. It determines who is permitted to bill the plan, […]
Category: News
PBM Transparency is coming. Here is what Plan Sponsors need to know
The Department of Labor’s proposed PBM disclosure rule just closed its public comment period — and the pressure to finalize it is intense. SHN breaks down what’s at stake for your plan. If you sponsor a self-insured health plan, you’ve probably wondered at some point whether your pharmacy benefit manager is being straight with you. […]
If Your TPA Never Pushes Back, They’re Not Protecting You
Compliance failures rarely announce themselves. They don’t show up with warning lights and sirens. They accumulate quietly — in a dependent verification that was skipped, a plan document that drifted from what’s actually being administered, an eligibility file that hasn’t been reconciled in months. By the time a plan sponsor discovers the problem, it’s usually […]
Healthcare Costs Are Climbing Again. Here’s How to Get Ahead of It.
If your health plan renewal is coming up and the numbers look worse than last year, you’re not imagining it. Employers nationwide — and especially here in Ohio — are bracing for another round of significant premium increases in 2026. For many organizations, healthcare now ranks among the top two or three expense lines. That’s […]
The MAPD Shake Up
The 2026 Medicare Advantage Shake-Up: What Retiree Plan Sponsors Need to Know Now The Medicare Advantage market is undergoing one of its most significant resets in a decade. For unions, municipalities, and large employers sponsoring retiree healthcare, the window to act is now — before renewal season narrows your options. Key Question: Is your retiree […]
The Next PBM Revenue Shift: Why Employers Should Prepare for the “Fee Era”
For years, Pharmacy Benefit Managers (PBMs) have faced growing scrutiny over how they generate revenue. Much of that criticism has centered on two well-known practices: rebate retention and spread pricing. Now, with federal regulators, state legislatures, and Congress actively targeting those revenue models, PBMs are adapting once again. The industry’s next pivot is already underway […]
Nearly Half of U.S. Job Seekers Are Saying the Quiet Part Out Loud: “Give Me Better Benefits!”
If you’ve been wondering why your job postings are getting ghosted harder than a bad Tinder date, here’s a clue: today’s job seekers want benefits—and they want them served hot, fresh, and better than whatever they’re currently getting.Indeed (yes, the job site, not me declaring something with flair) released a pair of reports showing that […]
When ACA Subsidies Shrink: What Small Employers Can Do to Support Their Employees in 2026
Many small employers are hearing the same concern heading into 2026: “My ACA subsidy went down — my premiums are going up — what do I do?” With subsidy reductions and higher plan costs, more employees are facing difficult decisions during open enrollment. Even if you don’t currently offer a group plan, you still have […]
Keeping Patients Safe with Pharmacogenomic (PGx) Testing
How Pharmacogenomic (PGx) Testing Is Keeping Patients Safe In healthcare, one size rarely fits all — especially when it comes to prescription drugs. Every person’s body processes medications differently, which means what works for one patient could be dangerous or ineffective for another. That’s where pharmacogenomic (PGx) testing comes in — a revolutionary tool that’s […]
Social Security Announces 2.8% Benefit Increase for 2026
October 24, 2025 | Baltimore, MD – The Social Security Administration (SSA) has announced a 2.8% cost-of-living adjustment (COLA) for 2026, benefiting more than 75 million Americans receiving Social Security and Supplemental Security Income (SSI). This increase means the average Social Security retirement benefit will rise by about $56 per month starting in January 2026. […]