CATEGORY: health-insurance

AI and machine learning revolutionize the health insurance industry

AI and machine learning revolutionize the health insurance industry

Health insurance policy changes at the federal level have captured the headlines in recent years, but in the long run some of the most profound changes to the industry have happened behind the scenes. The application of artificial intelligence and machine learning have impacted some of the industry’s most important practices.

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Why health plans lose money on payment integrity programs

Why health plans lose money on payment integrity programs

Health plans make large investments to automate outdated processes when it comes to claims payment integrity expecting significant savings. Unfortunately, with this approach the expected savings don’t always materialize.

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Factors leading to payment integrity challenges

Factors leading to payment integrity challenges

While the basic challenges to health insurance payment integrity remain largely the same – ensuring responsibility for the claim, the eligibility of the consumer, the coverage under the contract, the validity of the claim and the lack of fraud, waste and abuse – the range of factors that bear on those challenges has expanded over time. Fortunately, so have the capabilities of insurers to deal[…]

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10 Health Insurance Trends for 2019

10 Health Insurance Trends for 2019

For an industry that has undergone immense change in recent years, 2019 looks to be more of the same for health insurance. Some of the pressures come from standard sources such as governments, employers and providers, while others are driven by broader demographic or technological trends. Whatever the root cause might be, health insurers will continue to value adaptability, cost containment[…]

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Top big data analytics challenges in health insurance

Top big data analytics challenges in health insurance

While the benefits of big data analytics for health insurers are increasingly well known, the unique nature of the health insurance marketplace does create challenges that require careful and strategic work by insurers and their partners to address.

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