Understanding US Healthcare Affordability: What Millions of Eligibility Checks Reveal About Patient Cost Exposure

We’re excited to announce the launch of Network Status - a new capability that lets you define and manage network eligibility rules, so Nirvana can automatically determine in-network or out-of-network status on every eligibility check.

Starting January 2027, Medicaid work requirements will affect millions of expansion enrollees. Here's what behavioral health providers need to understand — and do now — to protect their patient panels and revenue.

We're excited to announce the launch of Medicare Advantage Identification – a new capability designed to improve Medicare coverage accuracy and eliminate ambiguity when verifying benefits for Medicare patients.

We’re excited to announce the launch of Blue Card Eligibility Identification - a new capability designed to improve network status accuracy and reduce ambiguity when working with BCBS plans.

Growing practices are discovering that manual eligibility verification that worked for 500 patients becomes unmanageable at 5,000. Administrative teams that once handled coverage checks efficiently find themselves overwhelmed. There are effective strategies to grow without these issues

Many practices try to patch over the problem with overtime or additional hires, or offshore solutions. But the relief is only temporary before you start seeing the same problems resurface. Here are four specific patterns that signal you've hit the tipping point where it’s time to consider automating.

Medicaid enrollment is expected to decline sharply over the next two years as these policies take effect. The Congressional Budget Office projects work requirements alone will generate $326 billion in federal savings through millions of patients losing coverage - when those patients can’t pay, their bill will become bad debt

Patients are dropping marketplace plans, shifting to Medicaid or employer coverage, or going uninsured. New sign-ups are down considerably in Pennsylvania and California, and state-based exchanges saw an 18% decrease in new customers overall.

H.R. 1 (the "One Big Beautiful Bill" Act) delivered the largest Medicaid restructuring in decades. The government shutdown delayed implementation guidance, but the CMS moved fast once the lights came back on - releasing two major guidance documents within a week of the November 12 funding resolution. The Congressional Budget Office projected $225.7