As healthcare organizations navigate the evolving digital landscape, interoperability has become more than a regulatory requirement—it’s…
Category: News
Case study: Prepay COB boosts payment integrity results for large national payer
The Host As he had wanted, President Donald Trump signed his big budget bill into a…
CCC25: 3 key pillars required to perform beyond healthcare challenges
As health plan leaders in quality improvement, risk adjustment, and payment integrity gathered for the Cotiviti…
Webinar: Reflecting on HEDIS MY 2024 and preparing for what’s next
The conclusion of another HEDIS® season offers health plans an important opportunity to evaluate their performance,…
Webinar: Billing and policy trends impacting your payment integrity program
While health plans seek to pay claims as accurately as possible, implementing new payment policies requires…
FWA Insights: Excessive dental restorations
As healthcare costs rise, dental costs have been no exception—recently increasing by $4 billion in a…
Webinar: Unlocking value from interoperability investments
As health plans continue to advance their digital transformation efforts, interoperability remains a critical driver for…
Risk adjustment: 4 strategies as CMS increases RADV audits
The Centers for Medicare & Medicaid Services (CMS) has introduced what it calls an “aggressive” approach…
Case studies: Performing beyond expectations in payment integrity
As healthcare utilization and per-unit costs continue to rise, health plans are looking to tighten their…
White paper: Commercial risk adjustment updates to prepare for in 2026
First introduced in 2014 as part of the Affordable Care Act (ACA), commercial risk adjustment aims to…