The Payer Operating Model 2030: What Connected, AI-Powered Health Plans Will Look Like
The payer operating model is being rewritten Health plans are no longer just administrators of care; they are also providers […]
Digital Transformation
Our Key Takeaways from Gartner® Hype Cycle™ for U.S. Healthcare Payers, 2024 Report
The healthcare industry is continuously evolving and with technological advancements, payers seek innovative ways to optimize operations, reduce costs, and
Future-Proofing Healthcare Data: Leveraging Cloud Platforms for Robust Data Protection
In healthcare, data is the primary keeper of information. Data in healthcare has high sensitivity and large volume, so cybercriminals
Medicare Advantage Compliance: Lessons from High-Stakes Penalties
In recent news, the healthcare industry has been abuzz with significant developments that carry vital lessons for Medicare Advantage plans,
The Transformative Power of GenAI in Healthcare Compliance and Operations
As a former U.S. healthcare operation management professional, I understand the complexities and dynamic nature of the healthcare compliance landscape.
Optimizing Appeal Decisions
Medical Directors need relevant Information. Health plans must identify the key pieces of information Medical Directors will need in order
Monitor Improper Payments for Part C and Part D with Medicare Audit and Monitoring Software
The monthly premium for Medicare Part B rose 14.5%, from $148.50 in 2021 to $170.00 in 2022, which is partly
FDR Oversight – Turning Policy & Procedure into Practice
Health plans (collectively, “plan sponsors”) that contract with the Centers for Medicare & Medicaid Services (CMS) to provide health services
Enhance Member Satisfaction by Accurately Classifying Grievances with AI-powered Grievance Management Software
Healthcare organizations establish Compliance Departments with the primary purpose of providing compliance oversight for the organization. Operational teams—such as the
Single Member Experience Platform
Leaders of healthcare organizations who must adhere to Medicare or Medicaid regulations face an important decision: manage member issues in