Early each year, the Centers for Medicare & Medicaid Services (CMS) publishes an Advance Notice of…
Category: News
Podcast: Artificial intelligence in payment integrity
As health plans look to artificial intelligence (AI) and machine learning to improve their operations and…
Navigating new frontiers in member engagement
As Medicaid redetermination continues and health inequities persist, personalized, technology-driven strategies are enabling health plans to…
10 tips for a successful commercial risk adjustment program
The Affordable Care Act (ACA) healthcare market is growing steadily, with over 21 million people enrolled…
Podcast: Deploying AI in payment integrity responsibly
Artificial intelligence (AI) and machine learning can help payment integrity programs achieve higher levels of value.…
Navigating new frontiers in interoperability
The growing demand for data sharing between payers and providers requires a commitment to interoperability and…
Checklist: How to build a valuable coordination of benefits program
Payers face rising costs, increased post-pandemic demand, and growing expenses, leading to unfavorable medical loss ratios…
Improving risk adjustment: Integrating internal and external innovations
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FWA Insights: Catching outlier behaviors in physical therapy claims
Fraud, waste, and abuse (FWA) significantly impact consumers by driving up healthcare costs, increasing insurance premiums,…
Busted: The top fraud schemes of Q2 2024
As we move through 2024, fraud, waste, and abuse (FWA) continue to be significant issues within…