Artificial Intelligence

With Proper Use, Artificial Intelligence Improves Health Plan Operations

March 5, 2024 - While artificial intelligence is far from a new concept, the healthcare industry has recently latched on to the technology, leading to increased adoption across many sectors. Artificial intelligence has the potential to lower healthcare costs and streamline administrative processes for health plans, but it can also have unintended, negative consequences for consumers. Artificial...


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Lawsuit Alleges Humana Used AI to Deny Medically Necessary Claims

by Victoria Bailey

Humana is facing a class action lawsuit alleging that the payer used an artificial intelligence (AI) tool to deny Medicare Advantage beneficiaries’ claims for medically necessary care. In a...

Top Payer Concerns, Opportunities Around Generative AI Integration

by Kelsey Waddill

Generative AI may become a fixture of the health insurance landscape, seamlessly integrated into common payer processes, reducing timelines from hours or days to minutes. But for now, the tool’s future is fraught with...

What Technologies Support Payers With Claims Management Processes?

by Victoria Bailey

Claims management is an integral part of the healthcare process as it determines how much providers receive in reimbursement, what costs health plans will cover, and what patients ultimately owe for their care. After providing care,...

UHC Introduces Employer-Sponsored, Virtual Care Physical Therapy

by Kelsey Waddill

UnitedHealthcare is introducing access to virtual care physical therapy for members in employer-sponsored health plans who suffer from musculoskeletal issues, according to an emailed press...

Walmart Launches Provider Recommendation Tool for Health Plan Members

by Victoria Bailey

Walmart has partnered with a healthcare machine intelligence company to offer a personalized provider recommendation tool to associates who receive healthcare coverage through the retail giant’s...

UPMC Health Plan Virtual Assistant Aims to Improve Access to Care

by Victoria Bailey

The University of Pittsburgh Medical Center (UPMC) Health Plan has launched a virtual tool to assist members with questions about benefits, coverage, services, and access to care. The health...

How AI Supports Low-Risk Member Identification, Care Management

by Kelsey Waddill

Artificial intelligence (AI) can shed light on trends within low-risk member populations so that health plans can prevent them from progressing into the high-risk category. There are a couple of key...

Humana, IBM Partner To Streamline Member Engagement With AI

by Kelsey Waddill

Humana has announced a partnership with IBM Watson Health that seeks to improve member engagement through artificial intelligence. The solution will use an artificial intelligence-enabled virtual...

How Payer Forecasting Is Shifting Towards Real-Time Data Analytics

by Kelsey Waddill

As aggregators of healthcare data, payers are modern-day seers for the healthcare industry and they are increasingly leaning on real-time analytics to perform this role. “Forecasting is a capability and an enabler to help create...

Anthem Earnings Call Projects COVID-19 Vaccine Impact, ACA Growth

by Kelsey Waddill

Coronavirus vaccine distribution and the new administration may have an impact on payers’ costs and marketplace growth in 2021, Anthem’s fourth quarter of 2020 earnings call...

3 Ways That Payers Leveraged Artificial Intelligence in 2020

by Kelsey Waddill

Payers used artificial intelligence to drive towards key objectives in 2020. Artificial intelligence is not a new technology, with the first artificial intelligence programs emerging in the early...

Centene Eyes Value-Based Care with AI Vendor Apixio Acquisition

by Hannah Nelson

Centene Corporation has signed a definitive agreement to acquire Apixio Inc., a healthcare analytics company that offers artificial intelligence (AI) technology solutions, in a move the payer said will...

How an AI App Navigates Narrow Networks, Cuts Healthcare Spending

by Kelsey Waddill

In the San Francisco Bay Area, employers face the challenge of escalating healthcare spending. This problem is not restricted to the Bay Area alone. Average premiums nationwide were around $7,470 for...

Anthem Skill Uses AI, Alexa For Medication Adherence, Engagement

by Kelsey Waddill

Anthem Blue Cross Blue Shield in Ohio (Anthem) developed the Anthem Skill to help members pursue medication adherence and better member engagement through Alexa-enabled devices. ”We work every...

How to Implement AI Platform to Fight Commercial Insurance Fraud

by Kelsey Waddill

“How do we get in front of commercial insurance fraud issues as early in the scheme as possible?” That is what Kurt Spears constantly asks himself as the vice president of financial...

Alignment Health Plan to Offer Concierge, Social Determinants of Health Benefits

by Emily Sokol, MPH

Alignment Health Plan will offer qualified Medicare Advantage members concierge services and social determinants of health benefits in 2020. The Southern California-based Medicare Advantage plan will...

Employers to Address Healthcare Consumerism, Innovation in 2019

by Kyle Murphy, PhD

The National Business Group on Health has released its top-five trends for the coming year, and employers clearly want to play a more involved role in healthcare transformation. Chief among their...