Claims Processing

Doctors and payers sit around a table discussing claims data, prior authorizations and more.
By Andrea Fox 11:06 am September 13, 2023
The payer says its new care management platform built on Salesforce Health Cloud helps understand members' care needs better and other tools reduce the processing time for benefits administration from 24 hours to five minutes. 
A nurse checking medication records on a laptop
By Adam Ang 03:26 am September 08, 2023
Also, Genea runs an integrated surgery management system powered by Clintel's CareRight.
In a plane, a copilot points to a destination on the horizon.
By Andrea Fox 09:18 am August 24, 2023
Also: eClinicalWorks now offers a suite of patient engagement capabilities through a collaboration between Ero Health and HealthTalk A.I.
Hands search a mobile phone.
By Andrea Fox 10:19 am August 22, 2023
In its first year at Medica, HealthRules Promote supported more than 400 configuration projects and yielded an estimated $750,000 cost savings, according to the company.
A black gavel lays on a desk
By Andrea Fox 09:30 am August 17, 2023
When Vanderbilt University Medical Center turned over non-anonymized medical records to the state without patient consent, it pitted Tennessee state law against HIPAA and unleashed a federal investigation as well as a class action patient lawsuit. 
Physician at computer
By Andrea Fox 10:58 am July 14, 2023
Health Care Service Corporation is using augmented intelligence to accelerate prior authorization – up to 1,400 times faster – and an AI tool that references historical authorizations and claims to authorize treatment "within seconds," the company says.
Clinician copies and pastes notes in an electronic health record
By Andrea Fox 02:20 pm July 07, 2023
The study of 1.7 billion clinical notes over a three-year period found an increase in the use of digital tools and copy/paste functionality correlated with longer notes and a decrease in the average time spent writing notes.
A clinician enters documentation on a tablet.
By Andrea Fox 10:28 am June 30, 2023
The company says it will infuse generative AI and large language models across the breadth of its AwareCDI product suite to streamline physician administrative burdens and to help hospitals and health systems capture more earned revenue.
Dr. Don Rucker, former National Coordinator for Health IT, discusses interoperability at HIMSS Global Health Conference & Exhibition
By Andrea Fox 08:44 am June 21, 2023
Dr. Don Rucker, now chief strategy officer with 1upHealth, weighs in on where TEFCA is headed and his fundamental concerns about veering away from the way the rest of industry computes.
Digital image of a brain with light beams that represents generative AI
By Andrea Fox 09:55 am June 07, 2023
LeanTaaS rolls out an AI autopilot in beta for its iQueue operations platforms, Carbon Health launches charting with artificial intelligence in its EHR and Clarify Health opens up Clara, its AI copilot, to select healthcare organizations.