The Cost of Compliance Variability in Healthcare Payer Operations
Compliance failures rarely begin with misconduct. They begin with variability. In healthcare payer operations, compliance risk rarely shows up as […]
Health Cloud Platform
Provider Dispute Management ROI: Manual vs. Automated Workflows
Manual management of Provider Dispute isn’t viable anymore Payer operations leaders know this: provider disputes are where efficiency goes to
Build, Buy, or Own: How Payers Are Reframing Technology Decisions
The debate has evolved, from build vs. buy to own. For years, health plans have wrestled with the same technology
CMS-0057-F Final Rule: How Health Plans Can Prepare for Prior Authorization Reform
CMS-0057-F is reshaping how health plans handle prior authorization, data sharing, and compliance transparency. This guide breaks down what’s changing, what’s at risk, and how payers can prepare to meet the 2026–27 mandates with confidence.
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
CMS Reminder to Practice Vigilance Against Medicare Fraud, Waste and Abuse(FWA)
On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and abuse (FWA) trending
Streamlining Medicare Advantage Organizations Member Communication: A Guide to CMS’s Model Materials for CY 2025
Every year, Medicare Advantage Organizations (MAO)1 must update their member communication materials, such as the Annual Notice of Change (ANOC),
Ensuring Accurate Drug Claims: Insights from CMS Audits and Best Practices
The Centers for Medicare & Medicaid Services (CMS) has added another category of drugs—immunosuppressants—to their national audits in collaboration with
Navigating the Intersection of Payment Integrity and Provider Relations in Healthcare
Payment integrity and provider relations are two critical pillars of a well-functioning healthcare system. When effectively managed, they can lead