Claims Processing

While 80% of a commercial bill is the plan's responsibility, 20% is owed by patients, says PayMedix CEO Tom Policelli.

 More than 7 million have lost Medicaid coverage, with states taking widely different approaches to the redetermination process, says John Barkett.

The payer says its new care management platform built on Salesforce Health Cloud helps understand members' care needs better and other tools reduce the processing time for benefits administration from 24 hours to five minutes. 

Also, Genea runs an integrated surgery management system powered by Clintel's CareRight.

Also: eClinicalWorks now offers a suite of patient engagement capabilities through a collaboration between Ero Health and HealthTalk A.I.

In its first year at Medica, HealthRules Promote supported more than 400 configuration projects and yielded an estimated $750,000 cost savings, according to the company.

When Vanderbilt University Medical Center turned over non-anonymized medical records to the state without patient consent, it pitted Tennessee state law against HIPAA and unleashed a federal investigation as well as a class action patient lawsuit. 

Payers and providers can prevent overwhelming administrative burdens with machine learning strategies that look at patient needs beyond a single transaction, explained Niall O'Connor, chief technology officer at Cohere Health.

Health Care Service Corporation is using augmented intelligence to accelerate prior authorization – up to 1,400 times faster – and an AI tool that references historical authorizations and claims to authorize treatment "within seconds," the company says.

The study of 1.7 billion clinical notes over a three-year period found an increase in the use of digital tools and copy/paste functionality correlated with longer notes and a decrease in the average time spent writing notes.