Reducing Costs and Complexity with EHR Workflows for Prior Authorization
The healthcare industry faces a constant challenge: balancing rising costs with the imperative to deliver high-quality care. Prior authorization has become a […]
Maximizing Member Retention: Transforming Pain Points into Positive Experiences
Member retention is paramount in a competitive healthcare landscape. A classic Harvard Business Review study revealed that a mere 5% increase in […]
Strategic Accelerations: Critical Business Initiatives for U.S. Healthcare Payers Part 2
In Part One of this series, we examined the initiatives Gartner identified as key areas for acceleration,1 following their extensive evaluation through […]
Strategic Accelerations: Critical Business Initiatives for U.S. Healthcare Payers Part 1
U.S. healthcare payers and third-party administrators (TPAs) face a complex array of business and technology initiatives driven by evolving market conditions and […]
Building Trust in Healthcare Payer Data: 3 Keys to a Reliable Data Quality Strategy
In the age of big data, healthcare payers and third-party administrators (TPAs) are overwhelmed by vast amounts of information, underscoring the importance […]
2026 CMS Interoperability and Prior Authorization: Key Strategies for Healthcare Payer Readiness
In January 2024, the Center for Medicare and Medicaid Services (CMS) issued the Interoperability and Prior Authorization Final Rule CMS-0057-F, heralding a […]
Achieving Member Retention Excellence: Strategies for Healthcare Payers
In today’s competitive healthcare landscape, member retention is paramount for all health plan types. Retaining existing members is significantly more cost-effective than […]
Navigating the TEFCA Terrain: A Roadmap for Healthcare Payers
In an era of paramount digital transformation, the Trusted Exchange Framework and Common Agreement (TEFCA) emerges as a pivotal beacon for healthcare […]
New CMS Prior Authorization Final Rule: Is Your Technology and Operations Ready?
The healthcare landscape is constantly evolving, and the Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule (CMS-0057-F) […]
Technology Investments Shaping the Future for Healthcare Payers
In an era where technological advancement shapes the landscape of industries, healthcare remains at the forefront of significant transformation. The findings from […]