By David Main DC – Of everything artificial intelligence was going to fix in healthcare, billing looked like the softest target. It is rule-bound, high-volume, repetitive. The code sets are published, the edits are published, the payer policies at least nominally so. If you had asked me three years ago where AI would land first and hardest, I would have said the revenue cycle without hesitating.
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Reported payers and health insurance industry news from EHVA.ai, UnitedHealthcare, Independence Blue Cross, Anthem Blue Cross and Blue Shield, CVS Health, CareFirst BlueCross BlueShield, Humana, UnitedHealth Group, Cigna Healthcare, AHIP, and more.
By Brian Robertson -To improve revenue cycle management (RCM) through AI, organizations first have to change how they see the revenue cycle itself. RCM is no longer operational support. It is a core driver of enterprise strategy, corner office and all.
By Anne Neal – For years, the industry has measured payment integrity success largely through recoveries, savings, and avoided overpayments. However, achieving those metrics often comes at the cost of significant abrasion that manifests as claims rework, provider tension, cash flow unpredictability, and poor member experience.
By Syed Sibt-e-Hassan – Most practices judge a good month by the balance in the bank. It is the slowest and least useful way to understand revenue. By the time a shortfall shows up in the account, its causes are weeks old and often past the point of recovery.
By Rafiq Ahmed – For decades, one of the most consequential numbers in healthcare was effectively invisible to the providers delivering care: what a payer actually reimburses a hospital for a given service. Health systems negotiated contracts based on internal assumptions, historical precedent, and incomplete intelligence about what the market was actually paying.
By Tyler Cobb – A certificate of insurance is a one-page summary issued as a convenience. It is not a policy, it confers no rights, and it says almost nothing about whether the endorsements behind it actually match what the contract requires. Third-party risk has become a primary exposure pathway for provider organizations.
By Jerry Smith – Drug affordability conversations often center on manufacturers and their high list prices. This focus overlooks the real cost driver: the complex pharmaceutical ecosystem.
By Megan Schmidt – Healthcare is spending billions to modernize the future while ignoring one of its most expensive operational failures. Provider data, the foundational information that determines who gets paid, where patients receive care, and how networks function, remains inaccurate across much of the industry.