Priya Nambiar

Referrals clear specialist visits; prior authorizations clear specific procedures.

Slow collections stem from prior authorization delays and payer denials, not random timing.

Payers exploit technicalities in filing deadlines to deny otherwise valid claims permanently.

Why insurers are quietly cutting reimbursement through algorithmic downcoding.

Medicare Advantage plans must now decide prior authorizations in seven days, not fourteen.

Insurers quietly eliminated prior auth rules without notifying practices.

AI wins on speed and consistency, but human billers still catch what algorithms miss.

AI-powered scrubbing catches denials that rule-based systems miss.

Look for vendors who report clean claim rates and days in AR, not just AI promises.

Hybrid teams of AI and human billers outperform either alone on denial appeals.