Claims Processing

Change Healthcare
By Mike Miliard 11:09 am February 06, 2025
Even as the number of impacted individuals has been again revised upward, industry leaders say there are silver-lining lessons to learn from the incident about security frameworks, third-party risk and basic cyber hygiene.
gavel on desk and judge's hands singing paper
By Andrea Fox 11:08 am January 13, 2025
The company says in a 46-page detailed argument that Epic sought to deliberately eliminate its ability to gain payer market share and "brazenly doubles and triples down on knowingly false statements about Particle in its motion."
man on hospital bed
By Andrea Fox 11:21 am January 08, 2025
A statistical analysis evaluated a refit of the Dementia AlgoRithm, which helps determine patients at risk for cognitive decline, using administrative claims data. It found the new models could be a game-changer for value-based care providers.
Nursing executives huddle with staff and discuss data on a tablet.
By Andrea Fox 11:02 am December 12, 2024
By incorporating frontline leaders' feedback, health IT companies are developing products that enhance their control over analytics and empower them with artificial intelligence-powered approaches to streamline daily tasks and improve patient access.
Dr. Mehmet Oz
By Susan Morse 01:20 pm November 20, 2024
Oz will cut waste and fraud within the country's most expensive government agency, Trump says.
Stethoscope on tablet
By Susan Morse 01:19 pm November 01, 2024
The intent of prior authorization - to make efficient use of health resources - has not worked, says Peter Ax of UpScriptHealth.
Doctor looks at a desktop computer screen in a medical office
By Andrea Fox 12:26 pm October 31, 2024
Also: SmarterDX launches tools to help hospitals overturn denials in minutes and recover lost revenue.
Female doctor reviews information on a tablet in a hallway
By Andrea Fox 10:43 am October 16, 2024
Also, athenahealth intros athenaOne for Behavioral Health, and Clarify Health empowers payers with AI-driven cost containment tools and quality improvement analytics.
Laptop on a table showing the parties in a video meeting
By Andrea Fox 10:29 am October 02, 2024
It's already happening: CFOs are getting Teams calls from their "CEO" asking for reports on financial transactions, says ChristianaCare CISO Anahi Santiago ahead of her appearance at the 2024 HIMSS Healthcare Cybersecurity Forum.
Man's hands show on bible and gavel at a table
By Andrea Fox 04:00 pm September 23, 2024
Despite a greater ability for healthcare entities to challenge regulatory decrees in court, increased litigation could result in unfavorable court decisions that are harder to fix, healthcare attorneys say.