What You Should Know:
- HealthEdge® and Codoxo announce a strategic partnership to provide healthcare payers with the industry’s most cutting-edge solutions and services.
- This partnership will streamline and enhance their respective end-to-end payment integrity processes by leveraging HealthEdge Source™ in conjunction with Codoxo’s GenAI-driven Unified Cost Containment Platform. By joining forces to deliver an end-to-end payment integrity solution, healthcare payers will benefit from
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Revenue Cycle Management | News, Analysis, Insights - HIT Consultant
Bluespine Raises $7.2M to Combat Medical Overbilling with AI
What You Should Know:
- Bluespine, an AI-driven claims cost reduction platform for self-insured employers, has secured $7.2M in seed funding to address the pervasive issue of medical overbilling in the US healthcare system led by Team8.
- The seed funding will accelerate Bluespine's adoption by US employers and brokers, as well as support further research and development.
Tackling the Healthcare Cost Crisis
Bluespine was co-founded by a team of technology experts with deep
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Payment Integrity in Healthcare: Challenges and Solutions
Whether you work in healthcare or are just a patient who has interacted with the healthcare system, it shouldn't surprise you to read that healthcare costs have been going up and are expected to continue to do so into 2025 burdening all stakeholders. Despite the obvious need to cut wasted healthcare spending, research suggests that the industry as a whole isn’t very good at it, with administrative spending being one of the biggest culprits. One study found that nearly one-third of excess U.S.
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Q/A: Vim CEO Talks Solving the Rising Tide of Healthcare Claim Denials
The U.S. healthcare system is grappling with a surge in claim denials and prior authorization requirements, creating significant challenges for both providers and patients. To shed light on this pressing issue, we spoke with Oron Afek, CEO of Vim, a company that assists over 20,000 providers and 80% of the largest U.S. payers with prior authorizations.
In this interview, Oron Afek provides valuable insights into the challenges and potential solutions related to claim denials and prior
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Hancock Health Selects revology to Manage Revenue Cycle Ops
What You Should Know:
- Revology, a provider of revenue cycle management (RCM) solutions, has announced a multi-year contract with Hancock Health to manage its RCM operations.
- Hancock Health expanded its partnership with revology after the RCM firm helped increase cash collections, resulting in an additional $10 million for the organization.
Addressing RCM Challenges in Healthcare
Healthcare organizations face growing challenges in managing their revenue cycles effectively.
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SmarterDx Launches AI-Powered Appeals Solution to Fight Payer Denials
What You Should Know:
- SmarterDx, a provider of clinical AI for revenue integrity, has announced the launch of SmarterDenials, an innovative AI-driven solution designed to help hospitals fight unjust claim denials.
- With denials on the rise, causing operational disruptions and revenue loss for healthcare providers, SmarterDenials empowers hospitals to generate stronger clinical appeal letters and secure faster and more accurate reimbursements.
Addressing the Growing
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Backed by Visa, Osigu Secures $25M to Modernize Healthcare Payments Across Latin America
What You Should Know:
- Osigu, an AI-powered platform for healthcare claims and revenue management in Latin America and the Caribbean, has raised $25 million in Series B funding led by IDC Ventures, with strategic participation from Visa.
- Visa's strategic investment and partnership will drive the development of real-time payment solutions for healthcare providers.
Addressing Healthcare Payment Inefficiencies
The healthcare sector in Latin America and the Caribbean faces
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FinThrive Integrates with Oracle Health Patient Accounting for Claim Management
What You Should Know:
- Enhanced Claims Management: FinThrive and Oracle Health have completed a collaborative development effort, now certified, that seamlessly integrates FinThrive’s claims management solution with Oracle Health Patient Accounting, enhancing claims processing for Oracle Health customers.
- Streamlined API Integration: This integration utilizes API technology to deliver a unified login experience and improve real-time claim edits, enabling Oracle Health users to
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HLTH: Blue Shield of California, Salesforce Partner on Real-Time AI Prior Authorizations
What You Should Know:
- Blue Shield of California and Salesforce are joining forces to tackle a major pain point in healthcare: the lengthy and often frustrating process of prior authorizations.
- The new AI-powered platform solution, built on Salesforce Health Cloud, aims to deliver near real-time prior authorization decisions, streamlining healthcare delivery and improving patient experience.
Addressing the Burden of Prior Authorizations
Prior authorizations are a
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The Fine Print of Health Insurance: Why Surprise Bills Are So Common?
Surprise medical bills can be a major headache for anyone, but they can be annoyingly common for those with high-deductible health insurance plans (HDHPs). In fact, half of patients with an HDHP state they have received a surprise medical bill, even though they have insurance coverage.
High-deductible plans typically feature lower monthly premiums but higher out-of-pocket expenses. However, these plans can leave patients on the hook for unexpected medical costs that they may not be able to
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