Few phrases raise blood pressure among doctors and patients like “prior authorization.” Ask any clinician and you’ll hear the same story: delayed treatments, endless back-and-forth, and vulnerable individuals left waiting while paperwork wins the day.
For providers, prior authorizations are a constant drain of time and energy. For patients, they can mean worsening conditions, missed windows for effective treatment, or even care that never arrives at all. And for payers, prior
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Revenue Cycle Management | News, Analysis, Insights - HIT Consultant
AdvancedCare Launches Inbox Health Partnership for 350 Behavioral Health Clinics
What You Should Know:
- Inbox Health, a patient billing and engagement technology platform, today announced a strategic partnership with AdvancedCare, an AI-driven practice management, EMR, and revenue cycle solution.
- The collaboration integrates Inbox Health’s automated billing communication and payment technology with AdvancedCare’s AI Clinical and Revenue Cycle Management (RCM) platform. This unified solution directly targets behavioral health and psychiatry clinics, segments often
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Denial Prevention AI: Ember Raises $4.3M to Cut Healthcare Denials by Over 57%
What You Should Know:
- Ember, the AI-native solution for denial prevention secures $4.3M in seed funding round led by Nexus Venture Partners and Y Combinator.
- Its platform uses deep knowledge of payer policies to cut denials by more than 57% and boost net collections by 25% for health systems.
The Denial Crisis: Fueling Burnout and Financial Loss
Healthcare providers nationwide face an intensifying crisis driven by claim delays and denials, which create significant
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Why Retrospective Audits Are No Longer Sustainable Against Rising Payer Scrutiny
In late 2023, a multi-hospital health system in the Southeast saw a sudden spike in payer requests for documentation. The compliance team had been running routine retrospective audits, but the pace of incoming denials and takebacks began to outstrip their ability to respond. Within six months, the organization reported more than $11 million in at-risk revenue and a doubling of external audit activity.
Despite their best efforts, the system was playing defense.
This story
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Thrivory Raises $25M Credit and $3.5M Equity to Eliminate Healthcare Reimbursement Delays with AI
What You Should Know:
- Thrivory, the AI-powered healthcare fintech company, has secured $3.5M in equity led by Redesign Health and up to $25M in credit from Trinity Capital.
- The funding supports the scale of its ThriveNow API, which embeds instant, non-recourse claims payments directly into EHR and practice management systems.
Solving Healthcare’s Biggest Financial Barrier: Slow Reimbursement
Thrivory, a healthcare AI company founded in 2023, is tackling the slow and unpredictable
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MedEvolve Acquired by Emergence: Accelerating AI-Powered Revenue Cycle Automation
What You Should Know:
- MedEvolve, Inc., a pioneer in AI-powered revenue cycle automation and analytics, today announced its acquisition by Emergence, an enterprise backed by The Pritzker Organization. Financial details of the acquisition were not disclosed.
- The strategic transaction combines MedEvolve’s proprietary Effective Intelligence® platform—which integrates workflow automation, analytics, benchmarks, and generative AI—with Emergence’s long-term orientation and deep
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AI Prior Authorization: Humata Health Partners with CMS on WISeR Model to Modernize Medicare
What You Should Know:
- Humata Health, a provider of AI-powered prior authorization technology, has been selected by the Centers for Medicare & Medicaid Services (CMS) as a key partner for its new initiative: the Wasteful and Inappropriate Service Reduction (WISeR) model.
- CMS, the single largest payer for healthcare in the U.S., has chosen Humata Health to deploy its proprietary technology in a program that directly addresses the staggering variability of care and significant
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Demystifying Prepay Coordination of Benefits: A Crucial Component of Payment Integrity
Coordination of benefits (COB) is a key component of any effective payment integrity program. But determining primacy for members with multiple plans and ensuring claims aren’t overpaid can be a complicated process. Whether it’s verifying employment status or sifting through complicated claims, COB takes significant time for peak accuracy. And while health plans focus on the intricacies of an effective COB strategy, many overlook the possibilities that a comprehensive prepay COB solution can
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Datavant and athenahealth Partner to Automate Medical Record Release at Scale
What You Should Know:
- Datavant, a data collaboration platform, and athenahealth, Inc., a provider of network-enabled software and services announced an anticipated partnership aimed at transforming the historically manual and fragmented process of medical record requests and releases.
- By bringing together athenahealth’s market-leading EHR platform with Datavant’s expertise in health data exchange, the companies plan to build a modern, comprehensive infrastructure for data
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The $168B Answer: How AI Can Tame Healthcare’s Untamed Administrative Beast
A quick google (or generative AI) search will pour hundreds of statistics about the dire state of healthcare costs plaguing our nation. Whether it’s the fact that we spend almost 5x as much as neighboring Canada per capita on healthcare administrative costs or that it means every 4th dollar spent is wasted, there are numerous scary statistics we have grown used to reading.
It certainly wasn’t meant to be.
How did a system designed to heal become so broken and smeared in complexity
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