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
Build, Buy, or Own: How Payers Are Reframing Technology Decisions
The debate has evolved, from build vs. buy to own. For years, health plans have wrestled with the same technology
How Disaster Declarations and Emergency Waivers Impact Health Plans
How automation protects compliance, revenue, and member trust For health plans, disasters don’t just test emergency response; they test compliance,
Why CMS and OIG Are Zeroing In on Conflict of Interest
What health plans must prove during audits Conflict of interest compliance is now a front-line issue for health plans. Regulators
TPA Compliance Risks for Health Plans: Is Your Third-Party Administrator/Vendor Putting You at Risk?
In the complex healthcare landscape, delegating critical functions to third-party administrators (TPAs) can streamline operations but also introduce significant compliance risks. With CMS intensifying oversight, health plans must recognize that accountability for every delegated action lies squarely with them. From data integrity gaps to missed SLAs, the hidden risks can lead to audit findings and financial penalties. Discover how a continuous, digital-first Delegation Oversight approach can transform your TPA management, ensuring compliance and protecting your members. Don’t let your vendors define your risk profile, take control and gain confidence in your oversight strategies.