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: claims payments
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 […]
Credentialing Isn’t Paperwork. It’s the Backbone of Your Network.
Every health plan and every provider network has a credentialing function. Not every health plan and every network has a credentialing *system* — and the difference between those two things is where most of the downstream pain in this industry comes from. Credentialing is the gate. It determines who is permitted to bill the plan, […]
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 […]