Why CMS audits are designed to test operations, not just documentation
For years, health plans treated CMS audits as documentation exercises. If policies looked current, files appeared complete, and evidence arrived […]
2026 CMS Program Audit Update: What Plans Must Do To Align
What Changed for 2026: Key Updates from CMS The 2026 audit update from CMS brings a fundamental shift in audit
CMS Policy Brief on AI for Payers
CMS Sets New Guardrails for AI in Medicare Advantage The New Regulatory Landscape: CMS Guidance on AI and Algorithms While
The CMS 2026 Program Audit Update: What I’m really hearing as a Chief Compliance Officer
When the 2026 Program Audit update landed, I didn’t read it as a checklist of changes. I’ve worked in healthcare
Unexpected Ways AI is Reshaping Payer Operations
It’s hard to ignore the constant headlines about Artificial Intelligence in healthcare. The integration of AI in payer operations is
The Delegation Oversight Operating Model of 2026-27
High-performing health plans are redefining delegation oversight with a data-driven, AI-enabled operating model that eliminates rework, strengthens compliance, and transforms audit readiness. This new model delivers cleaner universes, faster CAP closure, and real-time visibility across every delegated entity.
A payer’s guide to selecting the right A&G technology partner
Why vendor selection matters for health plans Appeals & Grievances (A&G) now shapes compliance outcomes, Star Ratings, and member loyalty.
The Payer Operating Model 2030: What Connected, AI-Powered Health Plans Will Look Like
The payer operating model is being rewritten Health plans are no longer just administrators of care; they are also providers
2026 CMS Program Audit Countdown: How Health Plans Can Prepare Now
The audit clock has already started CMS Program Audits follow predictable patterns, but most health plans still treat them as
Provider Dispute Management ROI: Manual vs. Automated Workflows
Manual management of Provider Dispute isn’t viable anymore Payer operations leaders know this: provider disputes are where efficiency goes to