AI in Health Insurance: How is it Being Used & Why?

Artificial intelligence (AI) is making its way into many industries, and the health insurance industry is no exception.

AArete Fraud, Waste and Abuse (FWA): Identification of Missing Rate Codes

A large Managed Care Organization engaged AArete to provide payment integrity cost-reduction support by reviewing their medical claims data, payment policies, state reimbursement guidelines, and provider contracts.

Payment Policies & Intelligent Edits

Medical Billing Needs To Catch Up With Modern Medicine

Payment Policies & Intelligent Edits

PHE & Healthcare: Why Health Plan Executives Need to Update Reimbursement Policies Post PHE

Member Benefits

Breaking Down Benefits to Improve Payment Accuracy

Top reasons benefits should be a focus, enabling healthcare payers to further improve payment accuracy

Payment Policies & Intelligent Edits

The Major Role Payment Policies and Related Edits Play in Payment Accuracy

Provider Contract Configuration

Diving into Details: Accurate Contract Configuration

8 Focus Areas for Accuracy of Provider Data Management that Impact Payment Accuracy

Errors in provider data account for the top reasons’ claims are pended or processed incorrectly, leading to frequent reprocessing and even potential fines, often attracting unwanted attention from providers, members, and regulators.