Claims Adjudication Automation

Transformation Without Disruption: How Access Healthcare Is Rewiring the Revenue Cycle with Agentic AI

Hospitals are juggling shrinking margins and rising costs while denial volumes remain stubbornly high. In the revenue cycle alone, hundreds of billions are lost annually to preventable errors and inefficiencies—in fact, Access Healthcare CEO Shaji Ravi cites more than $250 billion wasted each year. Meanwhile, payers have accelerated their use of AI to adjudicate…

SHMS Optimizes Operations for Medicare Advantage Plan Operators in the Healthcare Payer Enterprise

Enrollment in Medicare Advantage plans is projected to reach about 35.7 million, according to a 2025 Senate Finance Committee report. Yet, many startup and midsize organizations face steep technical and regulatory hurdles when launching or scaling operations. As part of the broader healthcare payer enterprise landscape, these plans must manage compliance, claims adjudication, risk adjustment,…