White Papers

White Paper: Getting Risk Adjustment Right - A Guide for Modern Health Plans

In 2024, Americans spent approximately $5.3 trillion on healthcare, about $15,474 per person, and healthcare expenditures accounted for 18.0% of the country’s GDP.

Navigating Dual-Eligibility: Regulatory Compliance and Strategic Opportunities for Health Plans

Dual-eligible individuals—those who qualify for both Medicare and Medicaid—represent one of the most complex and high-need populations in the U.S. healthcare system.

Digital Member Engagement Transformation: A Guide for Health Plans

White Paper: Elevating Payment Integrity - The Role of AI in Enhancing Payment Accuracy

Regulations are getting tougher, value-based care is expanding, and members now expect fast, seamless experiences. In this demanding landscape, achieving payment accuracy is more than just...

White Paper: Converge Without Limits

How Health Plans Can Turn Challenges Into Opportunities and Future-Proof Their Business

White Paper: Position Your Health Plan for Long-Term Success with Payment Integrity

White Paper: Compliance with Prior Authorization Mandates Is a Strategic Opportunity for Payers

A strategy to comply with the final rule issued by the U.S. Centers for Medicare & Medicaid Services suggests that payers should unify systems around their core claims and care management platforms...

White Paper: A New Paradigm in Payment Integrity - Taking an Enterprise Approach

Gain insights from a survey of health plan leaders on how to solve payment integrity challenges and achieve enterprise alignment.

White Paper: The Digital Payer Journey to Achieve a Coherent Individual Healthcare Experience

The individual healthcare experience has three dimensions. Each dimension requires deep application focus and an integrated approach to applications and data.

White Paper: Prospective Payment Integrity Moving from Pay and Chase to Predictive

This Spotlight examines payer payment integrity platforms and how payers can aggressively apply analytics and coordinate workflows to move "left" from reactive postpay to proactive, predictive prepay.

White Paper: Prospective Payment Integrity Solution Partner

Traditional multi-vendor payment integrity systems, while well-intentioned, often complicate IT environments with disjointed data sources and inconsistent workflows.

White Paper: Open & Flexible Care Management Systems to Transform Healthcare

In today's rapidly evolving healthcare landscape, traditional IT systems and monolithic care management solutions are becoming obsolete.

White Paper: Secondary Editing Platform

Don’t just simplify payment integrity. Choose the right partner to revolutionize it.

White Paper: Payment Integrity Medicaid

The intricacies and variability of state-by-state Medicaid regulations are presenting significant challenges for health plan executives, who must continually adapt to the latest Medicaid payment...