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Risk adjustment is central to Medicare Advantage plans—but as CMS ramps up RADV audits and implements extrapolation, the stakes for payers have never been higher. Inaccurate or unsupported HCC coding can now result in significant...

The Complexity of Claims Processing Imagine waiting weeks straightforward for claim approval of the health insurance claim process, all because a small piece of data was misplaced. This frustrating delay isn’t a rare exception—it’s an...

EFI’s modernization efforts, in collaboration with Quantiphi, culminated in the launch of an upgraded Sage Transparency 2.0 to enhance user experience and functionality. Leveraging AWS breakthrough services, the new platform integrates additional data sources like...

Quantiphi developed a virtual agent to handle a broader range of customer queries, thereby reducing call deflection

The integration of AI in healthcare holds immense potential, offering advancements in diagnosing diseases, optimizing treatment plans, reducing workload for clinicians and more. However, it is crucial to address the potential for algorithmic bias, which...