The Centers for Medicare & Medicaid Services (CMS) has introduced what it calls an “aggressive” approach…
Category: News
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…
FWA Insights: Solving durable medical equipment (DME) challenges
Fraud, waste, and abuse (FWA) in durable medical equipment (DME) billing continues to present costly challenges…
Star Ratings: 4 recommendations for the 2026 CMS Final Rule
Early each year, the Centers for Medicare & Medicaid Services (CMS) publishes an Advance Notice of…
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…