Claims Processing
A new partnership with NEJM and JAMA integrates peer-reviewed evidence with patient responses, says Abridge Clinical Strategy Director Matt Troup.
The goal is to streamline the time for payers to approve prior authorizations, for patients to get their care and for providers to get paid, says Lalithya Yerramilli, SVP of Payment Solutions for Cohere Health.
HHS is proposing to adopt certain HL7 FHIR standards and implement specifications for transactions related to prior authorizations.
Close to 60% of providers who responded to an HFMA survey say they have yet to implement AI or automation in the revenue cycle.
Insurers denied more claims on clinical grounds in 2025 compared with 2024, says new report.
Hospitals are on the receiving end of patients coming through the door who don't have the funds to cover services, says Seth Cohen, president of Cedar.
A whistleblower, a former Aetna risk-adjustment coding auditor, will receive $2 million.
Using real-time data and AI, core processes are becoming faster and more transparent, Optum says.
The agency gave Elevance a deadline of March 30 to submit data corrections to avoid the enrollment freeze.
The intelligent automation will deliver more timely decisions that reduce delays and improve access to care, Optum says.