SHN THOUGHT LEADERSHIP · SHNINC.ORG Automation Without Accurate Data Is Just Expensive Chaos By Anne Glorioso, CEO · Solidarity Health Network, Inc. · Cleveland, Ohio The healthcare industry is racing toward automation. And honestly? Good. It’s about time. AI-powered claims systems. Electronic prior authorization. Real-time interoperability. Automated repricing. Predictive analytics. Smart provider matching. […]
Tag: audits
Your Provider Roster Is Either Right or It’s a Problem
What ACA health plans — and the employers and brokers who work with them — need to know about provider directory rules, and why “close enough” stopped being good enough a long time ago. Let’s start with the uncomfortable truth: a lot of ACA health plans are out there right now with provider directories that […]
If Your TPA Never Pushes Back, They’re Not Protecting You
Compliance failures rarely announce themselves. They don’t show up with warning lights and sirens. They accumulate quietly — in a dependent verification that was skipped, a plan document that drifted from what’s actually being administered, an eligibility file that hasn’t been reconciled in months. By the time a plan sponsor discovers the problem, it’s usually […]