Claims Processing

So says Dr. Andrew Mellin, CMIO at Surescripts, who also predicts prior authorization will become less challenging as prescribers in greater numbers turn to automated prior authorization technologies.

At HIMSS26, leaders from HL7 Da Vinci Project and Aetna will show how C-suite leaders – and all patients – can benefit from the interoperability spec, which is enabling process automation for more informed decision-making about pricing.

The center uses the claims submission technology to automatically turn its clinical information into data appropriate for HEDIS measures to maximize its pay-for-performance reimbursement. Services are accurately captured for reporting and reimbursement.

Additionally, AI-driven workflows and advanced analytics will become crucial as hospitals face escalating financial and operational pressures in 2026, one CEO predicts.

Under a new indefinite delivery, indefinite quantity contract structure, Veterans Affairs said it can procure the data and technology it needs to better oversee the Veterans Community Care Program and hold contracted health plans accountable.

The agency confirmed that eligible Medicare telehealth reimbursements would be processed retroactively for virtual visits, and cleared up confusion on provider home address reporting requirements.

By deploying Epic's Coverage Finder and Digital Insurance Card Exchange for Medicare Advantage members, the health plan seeks to streamline and secure verification and check-in.

While the many dramas on Capitol Hill may make for interesting news cycles, "state government is the infrastructure of our political system." Just as states are in charge of medical licensure, many are leading the way on setting AI guardrails.

The two-month reprieve extends through January 2026. While some providers are restarting telehealth services, it remains unclear whether eligible virtual care reimbursements, accrued during the 43-day shutdown, will be approved for retroactive payment.

The AI-powered prior auth requirements under the CMS' Wasteful and Inappropriate Service Reduction model would increase provider burden and could harm patients since it prioritizes cost savings over medical judgment, the lawmakers say.