Feb 20, 2025 | AI in Healthcare, Payment Integrity
Navigating MLR Compliance with AI-Powered Healthcare Cost Containment Newsflash: Pressures are escalating for healthcare payers again. Faced with intense expectations to manage rising administrative costs while complying with strict medical loss ratio (MLR)...
Feb 11, 2025 | AI for PI Community, AI in Healthcare, Payment Integrity
Healthcare payers face an unprecedented challenge: maintaining financial integrity while preserving vital provider relationships. As claims volumes surge and complexity increases, traditional reactive approaches to payment integrity are no longer sufficient. The...
Dec 10, 2024 | Payment Integrity
As the healthcare industry continues to face mounting challenges in addressing accurate payment integrity due to complex healthcare claims processing, evolving reimbursement models, and fragmented data systems, healthcare leaders seek tools that will allow them to act...
Nov 5, 2024 | Payment Integrity
Like most SIUs, MVP Health Care’s SIU was faced with an overloaded team that was fielding requests from across the organization. Their goal was to be as responsive as possible to all requests coming into the department but had a desire to shift a portion of their...
Sep 9, 2024 | Payment Integrity
As our industry continues to delve deeper into streamlining and improving complex healthcare payments processes, healthcare payers are recognizing the increasing necessity to adopt new innovative methods to uphold and improve their payment integrity programs. The...
Aug 28, 2024 | Payment Integrity
Amidst a data-driven landscape, are healthcare organizations leveraging their data to its fullest potential? Data plays a crucial role in healthcare, powering everything from patient care to operations, billing and payments, and much more. The sheer volume and...
