Humana Will Slash Prior Auth for Medicare Advantage by 2026 — RCM Impact
Humana plans to reduce prior auth for Medicare Advantage by 2026. RCM teams will learn how this impacts workflow and denial rates.
Dozens of Insurers Cut Back on Prior Authorization — Impact on RCM Teams
Insurers are reducing prior authorizations, impacting RCM teams. Discover how these changes can streamline workflows and improve denial rates in your practice.
Med-Metrix Acquires CanAide — The Front-End RCM Land Grab Is Accelerating
Med-Metrix is acquiring CanAide to bolt Medicaid eligibility and enrollment onto its back-end RCM platform. PE-backed operators are sprinting upstream — here's what that means for health system procurement teams.
House Panel Votes to End WISeR Prior Auth Pilot — What It Means for RCM Teams
House panel votes unanimously to end the Medicare WISeR prior auth pilot. RCM teams will gain insight into its implications for billing workflows and compliance.
Black Book's 49-Category RCM Rankings Are Out — Here's What the Data Actually Tells You
Black Book ranked top vendors across 49 RCM categories based on 1,300+ provider surveys. What 78% said about payer friction, 74% about denial prevention, and 63% about AI auditability matters more than the vendor list.
CereVasc Raises $85M for AI-Driven eShunt System — Impact on RCM Teams
CereVasc's $85M funding will enhance its eShunt system. RCM teams must understand the financial implications and workflow adjustments ahead.
Wisdom Raises $28M to Enhance Dental Revenue Cycle Management Solutions
Wisdom raises $28M to enhance dental revenue cycle management solutions, promising RCM teams insights on product innovation and growth strategies.
British AI Clinical Workforce Platform TERN Group Raises €20M
TERN Group raises €20 million to address the healthcare workforce shortage. What AI-driven staffing means for RCM teams managing labor costs and productivity.
Congressional Push to End Medicare AI Prior Auth — Implications for RCM
Congressional Democrats aim to end Medicare’s AI prior auth program, impacting RCM workflows. Discover what this means for billing directors and revenue cycle leaders.
Cohere Health Raises $90M Series C to Scale Prior Auth AI Platform
Led by Temasek with $200M total raised. Cohere auto-approves 90% of the 12M+ prior auth requests it processes annually — and is now expanding into broader clinical decision-making.
The RCM Developer Problem Is Over
AI coding agents just closed the gap between knowing what to build and being able to build it. Here's what that means for revenue cycle teams that have been waiting on IT for years.
Prior Authorization is Breaking Trust—Time for a 21st Century Fix
Outdated prior authorization processes are undermining trust in healthcare. Here's what the CMS is saying and what it means for your revenue cycle.
Carlyle Bets Big on AI-Native RCM: What the Knack + EqualizeRCM Deal Means for Your Practice
Carlyle acquires majority stakes in Knack RCM and EqualizeRCM to build an AI-native, global, multi-specialty RCM platform. When PE at this scale bets explicitly on AI-native delivery, the bar for every RCM vendor just moved.
AI Enters the Fray: Can It Solve Our Denial and Underpayment Crisis?
Explore how AI can tackle denial and underpayment issues in revenue cycle management, offering innovative solutions for healthcare practitioners.
Ensemble + Cohere Are Building an RCM-Native LLM. Here's Why That's Different.
Not a GPT wrapper. Not prompt engineering. A fine-tuned model trained on real RCM operational data from 30+ health systems. The AI RCM arms race just shifted from model access to domain-specific training data.
AI Is Coming for Your Revenue Cycle. Here's What That Actually Means.
EY's new report on AI-driven RCM gets the framing right. But the transformation they're describing doesn't require a consulting engagement - it requires targeted automation against specific denial codes.
CMS Phases Out Fax Machines - What the Claims Attachments Rule Actually Means for RCM
$782 million in annual savings. Electronic claims attachments mandated by 2028. The fax era is officially ending.
Experian Health: The Credit Bureau's RCM Play - Data Moat, Patient Access, and What It Can't Do
Bureau-grade identity verification, credit-data propensity scoring, and Patient Access Curator AI. Best front-end platform for high-volume systems - but not end-to-end.
Is Your EHR Holding Back RCM Automation's True Potential?
Explore how your EHR system may be limiting RCM automation and discover strategies to unlock its full potential for improved revenue cycle management.
Denial Rates Surge as Prior Auth Rejections Plummet-What's Next?
The denial rate is climbing while prior auth rejection counts drop. What's driving the divergence and what it means for your AR.
What Fierce Healthcare's Fierce 15 of 2026 Signals for Revenue Cycle
The 2026 class is dominated by operational AI - not diagnostics, not therapeutics. Escher Health, Hyro, and Artisight have direct RCM implications. Here's what to watch.
MD Clarity Vendor Deep Dive: The Complete RCM Platform Review (2026)
MD Clarity helps healthcare providers optimize revenue by automating patient cost estimates and managing claim denials. Known for its robust rev
The RCM intelligence toolkit that pays for itself on one recovered claim.
Built by people who've worked the denials, coded the claims, and sat across from underwriters. Not theory - operational tools for the revenue cycle floor.
Also developing
Frequent MA Prior Authorization Denials Hurt Long-Term Care RCM Teams
Frequent MA prior authorization denials are impacting long-term care RCM teams, with over 30% of claims reportedly denied. Learn actionable strategies to combat this.
Medicare Advantage Insurers Face Backlash for High Prior Auth Denials
Medicare Advantage insurers reportedly denied 30% of prior auth requests. RCM teams will learn how to navigate these challenges effectively.
More intelligence
Prometheus Raises $12B for AI Innovations — Impact on RCM Teams
Prometheus secures $12B for AI innovations. RCM teams will learn how these developments impact billing processes and future revenue cycle strategies.
UnitedHealth’s Denial Rate Surpasses 15% — What It Means for RCM Teams
UnitedHealth's denial rate exceeds 15%, impacting RCM teams. Discover actionable insights to navigate this challenge and improve denial management.
CMS Creates Office of Health Technology and Products — What RCM Teams Need to Know
CMS stood up a new Office of Health Technology and Products (OHTP) on June 9, 2026. It owns claims platform modernization, FHIR interoperability, PECOS, and the National Provider Directory.…