AI Denial Prediction Models and Real-Time Claim Routing in RCM Platforms
Payers now deny claims at machine speed; practices need AI to keep up.
Colt Vanzetti
Contributing Editor, AI & Automation
Colt Vanzetti
Colt Vanzetti spent eight years as a software engineer building claims adjudication tools before pivoting to journalism to cover the intersection of machine learning and healthcare finance. He brings a technical fluency to his coverage that cuts through vendor marketing and interrogates real-world algorithm performance in payer and provider systems.
8 stories
Large Language Models in Medical Coding Assistance and Payer Response
Colt Vanzetti
Denial Rate Spikes Following Payer System Migrations and Platform Changes
Payer system overhauls are silently driving denial spikes that practices can't prevent on their own.
Colt Vanzetti
State Prior Authorization Reform Laws and Commercial Payer Applicability
State laws are filling the gap left by federal prior authorization rules that exempt employer plans.
Colt Vanzetti
Payer Formulary and Step Therapy Policy Changes and Their Billing Downstream Effects
Payers are tightening formularies now, not 2026, and practices losing revenue weekly by waiting.
Colt Vanzetti
National Coverage Determination Changes Affecting Outpatient Billing
Weekly NCD monitoring beats quarterly checks when CMS keeps rewriting the rules mid-cycle.
Colt Vanzetti
Cigna Clinical Coverage Policy Updates and Claim Submission Timing
Cigna's policy changes open coverage in some areas while closing it in others each cycle.
Colt Vanzetti
Medicare Advantage Audit Findings and Plan Compliance Outcomes from CMS
CMS audits reveal systematic prior authorization failures across 87% of Medicare Advantage plans.
Colt Vanzetti