New & Notable
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.
Survey: Front-end workflows to blame for most claim denials
Insurance eligibility and benefits verification, prior authorizations and patient registration errors are the top drivers of claim denials, according to RCM leaders in a new survey.
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.
R1 to acquire Humata Health for AI-driven prior authorizations
The acquisition, expected to close later this year, will leverage agentic AI to accelerate the prior authorization process and bring R1 closer to an autonomous revenue cycle platform.
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Latest News
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Survey: Front-end workflows to blame for most claim denials
Insurance eligibility and benefits verification, prior authorizations and patient registration errors are the top drivers of claim denials, according to RCM leaders in a new survey.
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R1 to acquire Humata Health for AI-driven prior authorizations
The acquisition, expected to close later this year, will leverage agentic AI to accelerate the prior authorization process and bring R1 closer to an autonomous revenue cycle platform.
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Health systems test real-time prior auths through Epic
Epic announced a new prior authorization API that four health systems are currently using to give clinicians and staff real-time access to requirements at the time of scheduling.
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Appeals court overturns No Surprises Act QPA calculation method
The 5th Circuit court struck down key factors insurers use to calculate payment amounts under the No Surprises Act, siding with providers who argued rates were artificially low.
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Cedar deploys agentic AI for patient billing, financial experience
Patients are increasingly responsible for paying their medical bills, Cedar said, making it imperative for the company to boost the patient financial experience.
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Value-based mandates linked to higher hospital admin costs
A study linked mandatory value-based payment models, like the CJR Model, to $3B in additional administrative costs for hospitals.
Features
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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.
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Amid staffing shortages, AI becomes medical coding's backup hire
Even competitive providers like UC Davis Health now use AI to support thinning medical coding teams, creating more tech-driven workflows and a fundamental shift in the workforce.