Claims Processing
In 2022, the AG launched an investigation into Mayo Clinic, which is ongoing.
Subsidiary UMR denied screenings when it should have determined whether the claims were medically necessary, the suit states.
AI can reduce denials by drawing on the complete picture of the patient, says Niall O'Connor, chief technology officer at Cohere Health.
The lawsuit claims the Cigna PXDX algorithm enables automatic denials for treatments that do not match preset criteria.
Leqembi is the first amyloid beta-directed antibody to be converted from an accelerated approval to a traditional approval.
The lawsuit alleges that Aetna took more than $1.3 billion from Kraft Heinz to pay providers.
It's important to have IT and operations work together and to get employees onboard, say experts speaking at HFMA.
This is driven by stronger inpatient trends and utilization in the ER, in outpatient surgeries and dental services.
Premiums spent on healthcare costs are expected to reach the upper bound of the MA insurer's full-year outlook.
The company's primary focus is on employers with 25-200 employees.