Manual handling of payer data creates backlogs, delays, and compliance risk. This infographic shows how AI-powered intake transforms unstructured inputs into automation-ready data that drives speed, accuracy, and trust.

Even one weak link in claims adjudication can slow turnaround times, increase audit risk, and strain provider relationships. Our new infographic helps health plans identify where their operations may be vulnerable and how optimized plans achieve stronger, faster, and more accurate results across five critical areas.

54% of Medicare beneficiaries are now in Medicare Advantage plans. Growth continues, but plan exits and rising costs highlight the need for resilient operations. Learn how health plans can prepare for greater complexity, compliance pressure, and scaling demands as enrollment heads toward 64% by 2034. 

Health plans are rethinking how contact centers serve members and providers. Angie Lanasa shares what plans often get wrong—and how to modernize.

Healthcare payers are under pressure to modernize claims operations while handling rising volumes, compliance demands, and member expectations. Success depends on more than technology: it requires a foundation of operational excellence built on three pillars: training, productivity, and quality.

CMS made key updates and issued 12 corrections to 2026 ANOC/EOC models. Learn what changed and how health plans can adapt workflows and reduce risk ahead of the next cycle.

Discover 4 costly CMS reconciliation pitfalls health plans face in MSP and COB processes—from data delays to audit risk—and how automation can solve them.

What are health plans really asking for in 2025? At AHIP this year, leaders across the industry shared unfiltered insights on the challenges they’re facing and what they expect from vendors. From digital operations and AI skepticism to the evolving complexity of member experience, here are three conversations that reveal what payers actually want—and how solution partners can rise to meet the moment.

CMS is dramatically expanding its Risk Adjustment Data Validation (RADV) audits—scaling from 60 plans per year to over 550. With tighter timelines, AI-driven scrutiny, and larger record samples, here’s how health plans should prepare.

Claims processing may not always make headlines, but its impact on a payer’s bottom line, compliance posture, and reputation with members and providers is massive. Billions are lost each year due to denials, rework, and delayed reimbursements. How can payers mitigate these risks?

Digital mailroom isn’t just about going paperless. It’s about making smarter, faster, and more compliant decisions at every stage of operations.

CMS data reconciliation is more than a technical process—it’s a strategic necessity for Medicare and Medi-Cal plans. Learn how to reduce audit risk, recover revenue, and protect the member experience.

A visual guide to how digital mailrooms capture, classify, and route incoming mail for faster, more efficient processing. Learn how intelligent document processing replaces manual mail handling with speed and accuracy.

In healthcare, “CX” — customer experience — is often viewed through a narrow lens. Too often, CX is reduced to a handful of familiar metrics: Average Handle Time (AHT), First Call Resolution (FCR), or Net Promoter Score (NPS). But in an increasingly complex payer environment, these alone don’t capture the full picture of how a member experiences your brand…

Many health plans hesitate to outsource their mailroom operations—but common misconceptions may be holding them back. This article addresses the top three myths about digital mailrooms and what plans stand to gain by partnering with an expert.

Claims processing is central to healthcare administration, but behind the scenes it’s often a maze of challenges—from provider friction to compliance risks—that impact both efficiency and relationships.

Electronic Data Interchange (EDI) is an electronic exchange of business documents between two or more trading partners. It allows businesses to exchange information in a standardized and automated manner, improving the efficiency and accuracy of data exchange. EDI has become increasingly important for businesses of all sizes and industries, as it streamlines business processes and reduces manual labor.

Outsourcing your claims adjudication team can provide several benefits to your organization. Here are a few key advantages of outsourcing your claims adjudication process…

In the fast-paced world of healthcare, workflow software is making a significant impact by streamlining processes and improving patient care. By automating repetitive tasks, reducing errors, and improving communication between healthcare providers, workflow software is enabling healthcare organizations to work more efficiently and effectively. With the ability to customize workflows to meet specific needs, healthcare professionals can focus on providing high-quality care to patients.

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