Blog
Explainable AI Is the Future of Payment Integrity
Healthcare leaders, take note: AI must evolve beyond denial-focused workflows and become a transparent,...
AI Alert July 2025
Early refills are an early warning signal to audit a pharmacy Codoxo uses Pharmaceutical Violations to identify...
How States Are Modernizing Medicare & Medicaid Integrity with AI
With Congress poised to reduce federal Medicaid funding by 12%, healthcare program integrity leaders face mounting...
From Denials to Prevention: The Radical Overhaul of Payment Integrity Has Begun
At the AI for PI Summit 2025, Lynn Garbee, Partner at HealthScape Advisors, delivered a strikingly candid and...
The Engine Behind Early Payment Integrity Intervention: Exploring Concept ClaimPilot
Rethinking Payment Integrity at the Concept Level In the face of rising healthcare claims complexity, mounting...
Redefining the Future of Payment Integrity & Healthcare Costs: Five Imperatives for Payers & Providers
Navigating a Pivotal Inflection Point The U.S. healthcare system stands at a critical juncture. With the cost of...
AI Alert June 2025
Navigating Medication Therapy Management: Policies, Practices, and Identifying Potential Fraud, Waste, and Abuse ...
The Cost of Doing Nothing – Why PostPayment Recovery Is No Longer Enough in Payment Integrity
The healthcare payment system is hemorrhaging money, and the traditional "detect and recover" approach in payment...
Congressman Obernolte Sees Artificial Intelligence as the Solution to America’s Healthcare Paradox: World-Class Care with Unsustainable Spending
A Policy Leader with a Technologist’s Lens At the 2025 AI for PI Summit hosted by the AI for Payment Integrity (AI for...
AI Alert May 2025
Fighting Bad Behavior: Addressing Fraud, Waste, and Abuse in Applied Behavior Analysis As Applied Behavior Analysis...
A New Payment Integrity Category at Point Zero: A Better Way to Contain Healthcare Costs While Improving Provider Experience
The U.S. healthcare system is at a breaking point. Healthcare payers are managing overwhelming claims volumes, with...
AI Alert April 2025
Peeling Back the Layer of Skin Substitutes
Maximize recoveries
uncover overpayments, billing errors, and fraud faster with AI-driven insights that identify patterns missed by traditional data mining tools