Category: Blog

In this second installment, we will focus on identifying and prioritizing new audits that health plans should consider implementing. With the healthcare landscape constantly evolving, staying ahead means adapting your audit strategy to tackle emerging challenges and opportunities. This process involves strategic planning and careful implementation to ensure success.

Insourcing payment integrity audits is a complex process that requires a strategic approach. We recommend a two-step method to ensure success. This blog series will guide you through this process, with Part 1 focusing on maximizing your current audit capabilities, and Part 2 exploring how to prioritize and implement new audits.

Healthcare costs are expected to rise 8% over the next year, due to inflationary pressures and increasing utilization rates . Provider billing processes continue to increase in complexity, while the Department of Justice estimates that fraud, waste and abuse may account for up to 10% of all healthcare spending

The Impact of Artificial Intelligence on Payment Integrity: Addressing Payer Challenges, Leveraging AI, and What Lies Ahead

Medicaid Redeterminations and their Impact on Payment Integrity and COB At the beginning of the COVID-19 pandemic, Congress enacted the Families First Coronavirus Response Act (FFCRA), which required Medicaid programs to keep members continuously enrolled through the end of the public health emergency (PHE) in exchange for enhanced federal funding. That continuous coverage ended on… Continue reading Overcoming The Administrative Challenges of Medicaid Redetermination

ClaimShark TPL/COB platform (Cobalt) can triple your internal savings with the existing team. Cobalt gives your team a  comprehensive TPL/COB platform that can bring in multiple data files (TPL, back sweep, CAQH etc.)

ChatGPT and AI’s Impact on Payment Integrity Ram Davaloor 4th June 2023 ChatGPT, a generative Al chatbot, gained popularity and momentum and reached 1 million users in just five days after release. A quick primer on ChatGPT – it’s a conversational Al chatbot built by OpenAl and released in November 2022. Generative Al applications, like ChatGPT… Continue reading ChatGPT and AI’s Impact on Payment Integrity