Claims Processing

Femtech developer Aspira Women's Health signs with Dana Farber to license a biomarker-based ovarian cancer diagnostic, a Madrona Venture Labs spin-out adds GPT-enabled virtual agents to billing automation and Dave, an LLM oncology tool, is born.

Point32Health, the parent organization of Harvard Pilgrim Health Care and other health insurance plans, has taken HPHC systems offline, and providers are unable to confirm patient eligibility.

The National Council for Prescription Drug Programs chose the company for its prescriber database because of "its national coverage, profile depth, flexibility and integrity," the council's president and CEO said.

The integration could help providers and payers that use the TriZetto platform to enhance revenue growth and streamline claims management, while improved interoperability elevates care quality.

 CMS has released a proposed rule to speed up prior authorization approval.

There's been a softening of healthcare organizations' confidence in the vendor, researchers say, with customers expressing concerns about a post-acquisition roadmap and dissatisfaction with communication around the RevElate RCM platform.

What does 2023 hold in store for managing and improving electronic health records – and what's next for what appears to be a market landscape that's quickly consolidating?

Doximity's AI-powered chatbot tool could reduce the time doctors spend on administrative burdens. Cofounder Dr. Nate Gross says the bar in healthcare is high and requires a prudent approach to generative AI. 

Trina Histon, vice president of clinical product strategy at Woebot Health, discusses incorporating digital health tools into the provider workflow.

The proposal provides a "valuable tool to support the electronic submission of healthcare information," said CMS Administrator Chiquita Brooks-LaSure. It would reduce provider burden and could save more than $450 million a year.