What You Should Know
Healthcare business operations and AI-led technology company Sagility announced its strategic acquisition of Chirok Health, a specialized provider of Clinical Documentation Improvement (CDI), medical coding, coding quality assurance (QA), and revenue integrity services.Carried out through its U.S. operating subsidiary, Sagility (US) Holdings Inc., the transaction is valued at approximately $32.35M. Canaccord Genuity LLC served as the exclusive financial advisor to Chirok
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Revenue Cycle Management | News, Analysis, Insights - HIT Consultant
Blue Cross MA and Tufts Medicine Partner with Humata Health and NEHEN to Automate Prior Authorization
What You Should Know
Blue Cross Blue Shield of Massachusetts (BCBSMA) and regional health system Tufts Medicine announced a comprehensive alliance, focused on prior authorization automation, value-based care design, and integrated clinical network delivery.Tufts Medicine is deploying Humata Health to automate and streamline prior authorization for Blue Cross members, starting with outpatient diagnostic imaging (such as MRIs), with scheduled expansion across additional clinical service
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Baba Raises $40M to Expand Medicare Applied AI Platform, Debuts BabaBench
What You Should Know
Applied artificial intelligence and healthcare navigation company Baba secures $40M in Series A financing led by FirstMark Capital with participation from CVS Health Ventures and value-based healthcare specialist Valtruis, alongside returning venture investors General Catalyst, Genius Ventures, and Ground Up Ventures.Introduces BabaBench (published on arXiv and accepted to an upcoming NeurIPS workshop): a specialized AI benchmark designed to evaluate how frontier
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MEDITECH Partners with Lifemed AI to Arm Hospitals Against Payer Claims Denials
What You Should Know
Healthcare electronic health record (EHR) vendor MEDITECH and healthcare artificial intelligence company Lifemed AI announced a formal enterprise partnership, designating Lifemed as an Accelerator-level member of the MEDITECH Alliance program.The partnership embeds Lifemed’s proprietary non-generative deep-learning neural network platform directly into MEDITECH’s nationwide hospital and health system EHR ecosystem to eliminate claims denials, automate pre-bill scrubbing,
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Otter Health Lands $8M to Replace Prior Authorization with Continuous Clinical Intelligence
What You Should Know
Healthcare utilization intelligence platform Otter Health announced its official commercial launch, backed by $8M in seed financing co-led by Fika Ventures and Evidenced, with participation from Slow Ventures, Metrodora, CoFound Partners, Layout Ventures, Patient Capital, and Semper Virens.Directly challenges the foundational premise of conventional utilization management (UM): while health plans have historically relied on prior authorization (PA) as a transactional
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Hospitals Can No Longer Afford to Manage Revenue Cycle After the Fact
For years, hospital finance teams have run revenue cycle on a familiar loop: a claim goes out, a claim comes back denied or underpaid, and staff spend the next several weeks working it back. That loop was manageable when denial rates held fairly steady and reimbursement was reasonably predictable. Neither of those things is true anymore, and the gap between how revenue cycle is typically run and what today's payer environment actually demands is widening fast.
Denials are climbing, and they
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Why Calling ICD-10 a Diagnosis Is Healthcare’s Costliest Design Flaw
Healthcare software colleagues of mine often describe a recurring discussion they have with their outsourced development teams. They recount that when they try to explain the difference between a billing diagnosis and a clinical diagnosis, the engineers on the other end deliver a common platitude: “a diagnosis is a diagnosis.”
That answer is defensible in ordinary English. In healthcare data, however, it is wrong in a way every team that accepts it inherits. The formal name of the
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AKASA Launches Autonomous Mid-Cycle AI for Inpatient Coding and CDI
What You Should Know
Healthcare revenue cycle generative AI company AKASA announced the commercial launch of its autonomous AI platform for the revenue cycle mid-cycle, expanding beyond AI-powered prebill review into fully autonomous execution for inpatient medical coding and clinical documentation integrity (CDI).Addresses the most complex, resource-intensive operational bottleneck in acute care: while human medical coders typically require 30 to 60 minutes per inpatient chart (with
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Ensemble Health Partners with Penelope to Shift Real-Time Policy Intelligence Upstream
What You Should Know
End-to-end revenue cycle management leader Ensemble Health Partners announced at its Healthcare Leadership Exchange, a strategic enterprise partnership with Penelope Health ("Penelope"), a real-time healthcare policy intelligence platform.The collaboration natively embeds Penelope’s structured clinical policy engine directly into Ensemble’s proprietary revenue cycle intelligence layer, shifting policy and medical necessity verification upstream before clinical care is
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Oracle Health Unveils Upstream AI Revenue Cycle Portfolio at Health and Life Sciences Summit
What You Should Know
At the Oracle Health and Life Sciences Summit, Oracle Health announced a major portfolio-wide expansion of embedded artificial intelligence capabilities across its Revenue Cycle Management (RCM) suite, scheduled for rollout in the coming months across U.S. healthcare organizations.The strategic deployment brings machine learning and generative workflows upstream into the earliest operational stages—spanning patient scheduling, financial clearance, clinical documentation,
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