By Matthew Hawley – Artificial intelligence has been touted as a “solution” to modernize many payers’ processes and functions, including their traditional payment integrity programs. Yet seeing AI as the answer to health plans’ administrative burdens is overly simplistic.
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The thought leaders in our community are good about sharing their thoughts on the issues of today. Here are the top read and shared guest posts of June that we think deserve sharing again.
By Matthew Hawley & Jonathan Starr PharmD – A patient receives automatic refills from a specialty pharmacy for a drug he no longer uses and ends up stockpiling $1 million worth of medication. A pharmacy miscalculates the number of units of a specialty drug prescribed for a patient, resulting in a claim that is $16,000 higher than necessary, yet the claim is paid for by insurance.