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.

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…

Imagenet, a leading digital mailroom, claims adjudication, contact center, and Print-to-EDI (P2E) solutions partner to health plans and managed care organizations for more than two decades, today announced the acquisition of CODY, which provides proprietary software, outsourced services, and consulting solutions for member communications and compliance to 71 health plans.

In the world of healthcare administration, claims processing stands as a pivotal function, ensuring that providers receive timely reimbursements for the services they render. However, behind the scenes, this process can become a labyrinth of challenges, from provider abrasion to compliance issues, and everything in between. The ramifications of these hurdles extend beyond monetary concerns, impacting provider relationships, regulatory compliance, and overall operational efficiency.

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.

Imagenet Give Back to Tampa Bay Essential Workers

Artificial Intelligence in the Healthcare Industry

Where Does Your Medical Claim Go After It Leaves Your Provider’s Office?

Why Would You Outsource Your Back Office?

Benefits of an External Call Center

What is EDI and Why Is It Beneficial to Your Business

3 Reasons Why You Should Consider a Workflow Management System