1. How is AI being used in Source now and planned for the future?
Now:
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- Advanced Custom Editing Enhancements– We continue to expand editing functionality and usability, giving payers greater control and precision in their payment integrity workflows.
- What-If Modeling 1.0 – A UI-embedded, self-service what-if modeling suite that empowers payers to model scenarios and understand downstream impacts without relying on manual processes or outside support.
- Global Edit Exceptions – Enabling manageable edit exception maintenance at scale, so large organizations can efficiently govern their editing rules without the operational burden.
Next:
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- Advanced Custom Editing Enhancements (continued) – Ongoing expansion of editing functionality and usability to meet evolving payer needs.
- Co-Pilot Functionality – AI-assisted co-pilot capabilities embedded across the breadth of the HealthEdge Source UI, designed to guide users, surface insights and streamline decision-making.
Future
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- Clinical Review Payment Integrity Offering– We are developing a next-generation clinical review capability that brings AI-driven payment integrity to the clinical domain, helping payers identify and address payment accuracy issues with greater clinical context and confidence.
2. For plans using HealthRules Payer, GuidingCare and Provider Data Management, do we need separate Payer Hub Connect instances for Payer/PDM integration and Payer/GuidingCare integration or can we use the same PHC instance for all applications?
Payer Hub Connect (PHC) is part of HealthRules Payer and acts as a consumer for the Provider Data Management integration. It also acts as a producer for the GuidingCare 3.0 integration. Customers can use the same PHC for all applications, although depending on volumes and testing, it may be beneficial to support multiple instances so that it scales appropriately based on each customer’s needs.
3. Can you please share the details on how to attend the compliance forum?
- Compliance Forum Registration: https://healthedge.com/regulatory-and-compliance-user-group/
- Compliance Newsletter sign up: https://healthedge.com/resources/regulatory-compliance
4. Where can I find more information on the CMS Interoperability related functionalities?
- Visit: https://healthedge.com/resources/regulatory-compliance
- Visit: https://healthedge.com/resources/regulatory-compliance/mastering-cms-compliance-bridging-x12-and-fh…
- Sign up for compliance forum: https://healthedge.com/regulatory-and-compliance-user-group/
- Sign up for compliance newsletter: https://healthedge.com/resources/regulatory-compliance