Claims Processing

Several new partnerships are deploying artificial intelligence to drive financial performance: filling underutilized OR schedules, pinpointing revenue leakage and improving medical coding accuracy.

Also: Ambience Healthcare's AI platform is now available in the Microsoft Azure Marketplace.

Almost 20% of healthcare workers polled recently said they spend more than 20 hours per month correcting billing errors. Artificial intelligence can help, but adding automation to billing systems is no easy task.

Even as the number of impacted individuals has been again revised upward, industry leaders say there are silver-lining lessons to learn from the incident about security frameworks, third-party risk and basic cyber hygiene.

The company says in a 46-page detailed argument that Epic sought to deliberately eliminate its ability to gain payer market share and "brazenly doubles and triples down on knowingly false statements about Particle in its motion."

A statistical analysis evaluated a refit of the Dementia AlgoRithm, which helps determine patients at risk for cognitive decline, using administrative claims data. It found the new models could be a game-changer for value-based care providers.

Oklahoma Cancer Specialists and Research Institute offers a case study in selecting and implementing information technology for the Radiation Oncology Alternative Payment Model.

Health insurance companies increasingly face challenges in capturing and collecting revenue. Save time and money and prevent provider conflicts by addressing claim errors before payment.

The No Surprises Act and the Transparency in Coverage Rule have brought new requirements for insurers. Deadlines for compliance are fast approaching, but we have the support and guidance you need. 

In the 2022 plan year, new requirements for improving healthcare cost transparency and encouraging consumer engagement will take effect. Here's what you need to know about the new NSA member ID and Advanced EOB requirements.