The following is a guest article by Gigi Yuen, PhD, Chief Data & AI Officer at Cohere
Prior authorization is entering a moment of major transition. New federal requirements and AHIP-backed commitments taking effect in…
What You Should Know
– Avalon Healthcare Solutions, the leader in diagnostic intelligence, has announced a strategic investment from Francisco Partners and WindRose Health Investors.
– The capital will be used to accelerate the expansion of…
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What You Should Know
– Firstsource Solutions has announced the acquisition of TeleMedik, a Puerto Rico-based pioneer in technological healthcare solutions. Financial details of the acquisition were not disclosed.
– The strategic move significantly strengthens Firstsource’s…
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The Accuracy-Adequacy Paradox
A regional health plan improved its provider directory accuracy by 8%, only to discover hundreds of specialists listed as “in-network” had moved or stopped practicing. Rather than losing coverage, the plan leveraged…
What You Should Know:
– A new 50-state analysis reveals that over half (51.7%) of U.S. private-sector workers are now enrolled in high-deductible health plans (HDHPs) as employers struggle to manage rising costs. The report…
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Kevin Deutsch, General Manager and SVP of Health Plan Solutions at Softheon
The upcoming Affordable Care Act (ACA) Open Enrollment (OE) period presents at least three major challenges for health plans: Legislative changes, double-digit premium…
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What You Should Know:
– New analysis of Texas hospital price data reveals a transparency paradox: discounted cash prices for common services are often significantly lower than the rates hospitals negotiated with commercial insurers, according…
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What You Should Know:
– Evidium, an innovative healthcare artificial intelligence company, has announced the close of its Series A equity funding round co-led by Health2047, the venture studio of the American Medical Association (AMA),…
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What You Should Know:
– Press Ganey, the leader in experience measurement, analytics, and advisory services for health systems and health plans, today released its extensive report, Healthcare consumer experience 2025.
– The report explores new…
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Naomi Murphy, J.D., Senior Vice President, COB and Data Mining, Cotiviti
Coordination of benefits (COB) is a key component of any effective payment integrity program. But determining primacy for members with multiple plans and ensuring…
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