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At A Glance Claim scrubbing technology helps healthcare providers submit clean, accurate claims from the start – improving accuracy, reducing denials and maximizing reimbursements. Key takeaways: Claim scrubbing is a critical part of claims management, designed to improve claim accuracy and catch errors before submission. Errors on claims are a leading cause for denials and…
Employers spend enormous amounts each year on chronic condition management. Yet behind most of those costs lies a single, connected issue: poor metabolic health. Six in 10 Americans live with at least one chronic disease, and four in 10 manage two or more. Together, they account for nearly 90% of the nation’s $4.5 trillion annual…
Medicare open enrollment is in full swing and big changes are on the way in 2026 for providers – from physician fee schedules to a pilot test of prior authorization requirements in some states. With that in mind, here are some things providers should consider when it comes to Medicare. 1. Changes to reimbursements. Reimbursements…
Large pharmacy benefit managers have come under scrutiny for their opaque business practices so much so that the term PBM has become mainstream. PBMs are routinely blamed for driving up costs of prescription drugs and have been regularly mentioned in the mentioned in the corridors of Congress as an industry needing reform. The top 3…
At A Glance Automated prior authorization solutions streamline workflows, simplify management across payer systems and offer advanced features to reduce manual effort — helping providers minimize denials and improve overall efficiency. Key takeaways: Prior authorization is a process used by providers and payers to determine if a patient’s insurer will cover a specific treatment before…
Healthcare claims denials are on the rise, despite more than a decade of industry-wide technological advances aimed at improving claims management processes. However, in recent years, the introduction of artificial intelligence (AI) into the healthcare ecosystem has begun transforming how healthcare organizations manage patient access — and the entire revenue cycle. This article summarizes a…
Over the past two decades, U.S. hospitals have absorbed nearly $745 billion in uncompensated care, according to the American Hospital Association. This burden continues to grow as hospitals struggle to verify active insurance. The task is made harder by patients frequently changing jobs, relocating and moving through a fragmented payer system that providers must track and…
Manual prior authorization workflows represent one of the most tedious and expensive aspects of the healthcare revenue cycle. However, despite access to automated prior authorization software, only 31% of providers use electronic prior authorizations, according to the Council for Affordable Quality Healthcare (CAQH). The CAQH predicts that providers who switch to automated prior authorization software…
