Payer Policy Intelligence
Medicare Advantage Plan Policy Divergence from Traditional Medicare
MA plans deny coverage far more often than Traditional Medicare does.
Renata Osei-Bonsu
· 10 min read
Claims Current — Page 4
UnitedHealthcare 2025 LCD Policy Shifts and Billing Impact
Five stacked billing rule changes will auto-deny claims across labs, imaging.
Renata Osei-Bonsu
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
Commercial Payer Denial Rates by Specialty in 2024 and 2025
Denial rates now depend on specialty, payer mix, and algorithmic behavior.
Marcus Delgado-Wren
AI-Generated Prior Authorization Denials and the eviCore and Cohere Health Models
How two AI vendors control prior authorization denials across American healthcare.
Marcus Delgado-Wren