When was the last time your team won an appeal on a clinical validation downgrade? If you have to stop and think about it, you are not alone.
Payer behavior has made this harder than it used to be. Clinical validation audits are driving a marked rise in Diagnosis-Related Group (DRG) downgrades, forcing hospitals to defend diagnoses that, for years, were accepted on the strength of a physician's documentation alone. As audits grow more frequent and the criteria keep shifting, traditional
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Health IT | News, Analysis, Insights - HIT Consultant
Re-Engineering Workflows to Bridge Healthcare’s AI ROI Gap
Artificial intelligence (AI) has now reached a crucial tipping point in the way U.S. healthcare plans carry out their operations. A study by Everest Group, supported by Sagility, found that 70% of health plans have introduced AI tools to streamline both administrative and clinical activities. Nevertheless, 84% of payer executives say that they have seen limited benefits from these implementations and just 10% have noticed measurable improvements in operations.
The fact that these systems are
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The Biggest Vendor Risk in Healthcare Isn’t in the Operating Room
Over the past two years, healthcare leaders have been forced to rethink what operational resilience really means.
The cyberattack on Change Healthcare demonstrated how dependent providers had become on a single third-party platform for everything from claims processing to cash flow. The attack on Ascension showed how quickly disruptions to technology can spill over into clinical operations, delaying care, forcing clinicians back to paper documentation, and disrupting the day-to-day
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Patient CRM Modernization: Four Decisions Technology Can’t Make for You
Consider a daughter who signs up for disease information on behalf of her father. Weeks later, he enrolls in copay assistance and asks another website for updates. To the family, this is one patient's experience. To fragmented systems, it can look like three unrelated records, and one of them belongs to a different person.
The difference matters more than it first appears. A duplicate email is an annoyance. Treating a caregiver as the patient, or carrying a permission from one program into
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The Missing Line Item in Healthcare AI ROI Is Exception Handling
Healthcare executives often evaluate artificial intelligence with a familiar checklist: model accuracy, integration effort, implementation time, and license cost. That list omits the expense that determines whether an administrative AI project creates capacity or creates another system to supervise. The missing line item is exception handling.
The demand is real. In its 2026 Physician Survey on Augmented Intelligence, the American Medical Association reported that 81 percent of respondents
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Vera Health Raises $28.5M for Clinical AI Search Engine: Surpasses 800,000 Global Physician Users
What You Should Know
Clinical artificial intelligence search platform Vera Health announced the closing of a $28.5 million Series A funding round led by Threshold Ventures.The financing included participation from Mantis VC and SV Angel, with existing institutional backers Y Combinator and Gradient tripling down on their initial investments, bringing total capitalization to $32M.Operates at high capital and workforce efficiency: with an engineering and clinical team of only 12 employees, the
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AI Won’t Break Healthcare Payments. Poor Infrastructure Will
Every executive discussion about AI eventually arrives at risk. Will AI make the wrong decision? Will it create new security vulnerabilities? Will it introduce compliance challenges that organizations aren't prepared to manage?
Those are important questions. But when it comes to payments, they're often not the first questions organizations should be asking. The bigger issue is that many organizations are layering AI on top of payment infrastructures that were never designed for the speed,
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MDX Hawai’i Partners with Innovaccer to Deploy Atlas Across 6,000 Independent Clinicians
What You Should Know
Leading healthcare intelligence and AI infrastructure company Innovaccer announced that MDX Hawai’i has selected Innovaccer as its enterprise technology partner for population health management.MDX Hawai’i operates as the state's premier independent practice association (IPA) and management services organization (MSO), serving for 40 years as the primary operational link between commercial/Medicare health plans and community providers across the Hawaiian Islands.The
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Hospitals Need Authority Maps for AI Agents
Hospitals are beginning to give AI systems something more consequential than the ability to generate text: permission to act. That shift is already underway. A September 2026 survey of 250 U.S. healthcare leaders found that 28% of organizations had agentic AI in production and another 44% were piloting it, while 72% reported AI tools or agents deployed without formal IT approval. The problem is no longer simply whether a hospital has an AI governance committee. Health systems need to know, agent
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Clinisys Unveils AI Innovation Roadmap: Introducing CLS MCP, No-Code Workflows, and Specialized Laboratory Agents
What You Should Know
Global laboratory informatics provider Clinisys officially unveiled its AI Innovation Roadmap, establishing an open, governed platform strategy designed to embed artificial intelligence, analytics, and workflow automation into routine laboratory operations.The roadmap articulates a compounding evolutionary progression that advances laboratory informatics across four distinct architectural phases: from a System of Record to a System of Workflow, a System of Intelligence,
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