New & Notable
New analysis points finger at payers for IDR problems
Specialty medical groups submitted an analysis to Congress showing payers are responsible for most provider IDR wins despite their widespread complaints.
Oracle Health launches 5 AI revenue cycle tools to prevent denials
Oracle Health will roll out five embedded AI capabilities in its revenue cycle solutions that target prior authorizations, coding and charge capture to prevent claim denials.
Insurers deny less just to claw back more later: analysis
An analysis shows that claim denial rates are falling slightly, but providers aren't necessarily seeing an improvement in revenue as payers seek clawbacks.
Texas hospitals sue Independence Blue Cross over denied claims
Five HCA-affiliated hospitals want over $345,000 in what they say Independence Blue Cross owes them from inappropriate denials under the controversial BlueCard program.
— Healthcare DiveHHS adds new IDR entity as surprise billing disputes surge
— Healthcare DiveConifer to lay off over 1,000 workers
— Healthcare DiveSponsored Sites
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Revenue Cycle Management
Greenway Health
Improving healthcare through innovation is at the heart of Greenway Health’s work. We provide electronic health records (EHR), practice management, and revenue cycle management solutions that help practices in multiple specialties grow profitably, remain compliant, work more efficiently, and improve patient outcomes.
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Specialty Drug Management
Optum Specialty Fusion
At Optum, we’re evolving health care so everyone can have the opportunity to live their healthiest life. It’s why we put your unique needs at the heart of everything we do, making it easy and affordable to manage health and well-being. Together, for better health.
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Risk Adjustment Compliance
RAAPID
RAAPID develops AI-powered risk adjustment solutions for healthcare payers, providers, and supporting organizations. The company's HITRUST-certified platform uses Neuro-Symbolic AI to identify chronic conditions, determine HCC codes, and provide explainable documentation for complete audit defense. Backed by M12 (Microsoft's venture fund), RAAPID serves organizations participating in Medicare Advantage, ACA, Medicare ACO, and Medicaid programs with both retrospective and prospective risk capture capabilities. Founded by healthcare technology veterans with over 20 years of experience, RAAPID is headquartered in Louisville, Kentucky.
Healthcare Strategies: A Podcast
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A podcast for healthcare professionals seeking solutions to today's and tomorrow's top challenges. Hosted by the editors of Xtelligent Healthcare Media, this podcast series focuses on real-world use cases that are leading to tangible improvements in care quality, outcomes, and cost.
Guests from leading provider, payer, government, and other organizations share their approaches to transforming healthcare in a meaningful and lasting way.
View All Episodes
Latest News
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New analysis points finger at payers for IDR problems
Specialty medical groups submitted an analysis to Congress showing payers are responsible for most provider IDR wins despite their widespread complaints.
-
Oracle Health launches 5 AI revenue cycle tools to prevent denials
Oracle Health will roll out five embedded AI capabilities in its revenue cycle solutions that target prior authorizations, coding and charge capture to prevent claim denials.
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Insurers deny less just to claw back more later: analysis
An analysis shows that claim denial rates are falling slightly, but providers aren't necessarily seeing an improvement in revenue as payers seek clawbacks.
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Medical debt impacts 1 in 3 insured adults
Health insurance coverage doesn't protect everyone from incurring medical debt, with most debt totaling $2,000 or more.
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R1 adds AI utilization management for denial prevention
The company's new Phare Utilization Management tool layers payer-specific intelligence onto a clinical AI engine to identify medical necessity denials in real time.
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Medicare cuts will jeopardize physician practices, groups say
Healthcare providers slammed planned reductions to Medicare physician reimbursement next year, while supporting more structural changes to how the program pays them.
Features
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Payers say AI doesn't deny care. The truth is more complex.
Payers say AI is not clicking the deny button on prior authorizations and provider claims, but the technology does play a key role in deciding which requests need further review.
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How providers can weather Medicaid cuts when many won't
Federal Medicaid reform will affect providers differently, with some more at risk of closing while others can innovate their way out of severe revenue losses.
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Prior authorization automation hinges on human connection
Healthcare is rapidly automating the prior authorization process, but Ochsner Health has found that a new initiative connecting payers and providers is making progress tangible.
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What providers really need to streamline prior authorizations
Providers have yet to see much progress on a pledge last year to streamline prior authorizations, signaling misalignment between payer promises and meaningful change for providers.