10 Features Every Payer Compliance Automation Platform Must HaveÂ
For health plans, compliance is no longer a back-office task. It is central to protecting revenue, meeting CMS and state
Healthcare Operations
Internal Audit: Why Health Plans Can’t Rely on Generic Internal Audit Tools
Why most internal audit tools don’t work as expected for health plans Every year, CMS program audits trigger millions in
CMS-0057-F Final Rule: How Health Plans Can Prepare for Prior Authorization Reform
CMS-0057-F is reshaping how health plans handle prior authorization, data sharing, and compliance transparency. This guide breaks down what’s changing, what’s at risk, and how payers can prepare to meet the 2026–27 mandates with confidence.
Agentic AI and AI Agents for Payers: The Future of Compliance and Operations
Agentic AI models and AI agents for payers are transforming how health plans manage compliance, audits, and operations. These intelligent
Simplifying Prior Authorization Processes in HealthcareÂ
CMS’s comprehensive updates focus on improving beneficiary access, promoting transparency, and streamlining PA processes. Here’s what you need to know
CMS 2024 Call Center Monitoring Performance Metrics for Timeliness – Quarter 4 Study
Ensuring Benchmark Adherence in Call Center Operations The Centers for Medicare & Medicaid Services (CMS) plays a pivotal role in
From SaaS to Agentic PaaS: The Next Frontier of Healthcare Technology for Payers
By Mohar Mishra, CTO, Inovaare The healthcare payers landscape has become increasingly complex, with regulatory requirements, operational inefficiencies, and data fragmentation presenting formidable challenges. Conventional compliance and operational
How to Manage Prescription Drug Event (PDE) Data & Manufacturer Discount Program (MDP) in 2025
Two major provisions of the Inflation Reduction Act (IRA) that take effect in 2025 will require refresher training, even for
How Health Plans Can Use LLM Solutions to Cut Costs and Boost Operational Efficiency
The healthcare industry is undergoing a rapid digital transformation, driven by advancements in technology and the increasing pressure to improve
Medicare Prescription Payment Plan (M3P) Implementation: Key Considerations for Part D Plan Sponsors and PBMs
The upcoming Medicare Prescription Payment Plan (M3P), set to launch in January 2025, marks a significant shift in Medicare’s approach
Streamlining Medicare Advantage Organizations Member Communication: A Guide to CMS’s Model Materials for CY 2025
Every year, Medicare Advantage Organizations (MAO)1 must update their member communication materials, such as the Annual Notice of Change (ANOC),
Navigating the Intersection of Payment Integrity and Provider Relations in Healthcare
Payment integrity and provider relations are two critical pillars of a well-functioning healthcare system. When effectively managed, they can lead