The healthcare industry is entering another period of significant change. Medicaid and Medicare remain the mainstay of public healthcare programs, and both are undergoing shifts in enrollment, reimbursement, regulation, and financial oversight. Those shifts create new challenges for health plans, MSOs, IPAs, and other delegated-risk organizations. As of July 1, 2024, 84.8% of Medicaid beneficiaries (more than 73 million beneficiaries) received some or all of their care throug

Every health plan and IPA/MSO operating under a risk-sharing arrangement has had some version of this conversation: a claim arrives, neither party agrees on who pays it, and a routine adjudication becomes a weeks-long exchange. Multiplied across thousands of claims a month, what looks like operational friction is a structural revenue leak: one that rarely appears as a single large write-off, but as thousands of small ones. A Division of Financial Responsibility (DOFR) is the

In healthcare, documents are everywhere. From eligibility letters and compliance notices to audit reports and patient communications, teams rely on documents every single day to keep operations moving. And yet, for many organizations, document management is still one of the most frustrating and time-consuming parts of the workflow. Not because teams aren’t working hard but because the systems they use weren’t designed to work together. The Reality Most Teams Face In many heal

Key Software, Inc. was excited to participate in this year’s HICE (Health Industry Collaboration Effort) Conference on December 8–9, where leaders from across the healthcare landscape came together to discuss the future of operational innovation. Throughout the event, our team connected with forward-thinking health plans, MSOs, and technology partners who are actively seeking smarter, more streamlined ways to strengthen their operational infrastructure. The energy at HICE rei

In today’s complex operational landscape, managing documents across multiple systems, formats, and delivery channels is no easy task....

With rising claim volumes, complex regulations, and pressure for faster reimbursements, manual processes—and even basic automation like...

As the healthcare landscape continues to evolve, Management Services Organizations (MSOs) are emerging as a critical link between...

Based on data from Similarweb, 23andMe.com experienced its highest surge in traffic in two years on Monday following reports of the...

In the healthcare industry claims processing can be burdensome. The manual process is error prone and requires time, energy, and...