What is on the horizon for healthcare payer technology in 2026? In this annual report, ClarisHealth and industry experts review the trending drivers – and associated opportunities – so health plans can innovate payment integrity while minimizing risk.
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Fraud, Waste and Abuse
2026 Payment Integrity Technology Trends: The Shift From Savings Engine to Enterprise Control
Will Artificial Intelligence Finally Make Good on its Promise to Healthcare?
Artificial Intelligence is making the leap from much-hyped “trend” for healthcare technology to more widespread adoption. Here’s what A.I. is — and isn’t — and how health plans are proving its value. Artificial Intelligence for healthcare has come a long way since...
Health Plan Leaders Speak Out on Building the Payment Integrity Organization of Tomorrow
Whether or not health plan leaders implement a fully centralized PIO, sharing information on an enterprise payment integrity technology platform helps overcome challenges and meet strategic opportunity.
Here’s What You Don’t Know about Fraud, Waste and Abuse
Fraud is different from Waste and Abuse, and most technology solutions don’t adequately address either issue. Think you know how to manage fraud, waste and abuse at your healthcare organization? CMS doesn’t agree. In fact, the promises of change and reform coming from...
Lack of Documentation is a $23 Billion Overpayment Problem for Medicare
Medicare overpayment is a massive problem, and lack of documentation is a significant contributor. When we see errors adding up to billions of dollars in improper payments, we pay attention. As payment integrity technology experts and also healthcare consumers we take...
Prepare for CMS Audits: A Guide
Here's what to expect following new CMS payment integrity initiatives, including a guide to CMS audit protocols. The pressure is on for state-administered Medicaid programs (and the MCOs that run them). New initiatives released over the summer by CMS promise increased...
Fraud, Waste & Abuse is Not Total Payment Integrity
Don’t settle for “good enough” when a better solution exists. Fraud, waste and abuse (FWA) is a serious problem, one that can also be seriously misleading for healthcare payers looking to transform their revenue streams. That’s because many health plans mistake strong...