The healthcare industry is making significant progress on electronic prior authorization. Standards are maturing, federal requirements…
Category: News
Next in risk adjustment: Auto-linking charts to encounters
In April 2026, the Centers for Medicare & Medicaid Services (CMS) announced excluding diagnosis codes from…
Preparing for what’s next: Risk adjustment strategies for 2027 and beyond
In Q4, Medicare Advantage risk adjustment leaders are balancing two critical priorities: closing out the current…
CMS 57F: A shift from API implementation to member education
The industry has been rightly focused on implementing the technical infrastructure required to support new health…
Closing the year strong: Medicare Advantage risk adjustment priorities for Q4 2026
For Medicare Advantage (MA) risk adjustment leaders, the second half of the year often feels like…
Q&A: How to build a more coordinated program integrity strategy
As healthcare delivery becomes more complex and bad actors gain access to increasingly sophisticated technology, combatting…
AI in healthcare: The readiness challenge
Cotiviti and MedCity News just published the 2026 Healthcare AI Readiness Index revealing fascinating insights, including…
Webinar: A strategic approach to Medicare Advantage enrollment shifts
States bet big on rural health startups, with a Silicon Valley twist When Josh Fleig, Louisiana’s…
FWA Insights: Identifying non-emergency transportation billing risks
Non-emergency transportation is an essential function that helps Medicaid members access necessary care when they cannot…
Modernizing Medicaid through payment integrity, interoperability, and early intervention
The annual Medicaid Enterprise Systems Conference (MESC) is one of the premier events for state Medicaid…