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The Death of the Black Box: Why Transparency is the New Competitive Advantage in Payment Integrity

The healthcare industry is at a turning point: payers and providers alike are demanding more from payment integrity than opaque rules engines and audit surprises. While black-box vendors have long promised value, their lack of transparency can lead to costly misalignment, internal dependency, and missed opportunities for learning and waste prevention.

This session will explore the hidden costs of opacity in traditional payment integrity models and offer a modern alternative. We’ll examine how health plans can reclaim ownership of their payment integrity strategy by shifting to AI-powered platforms to empower internal audit teams (0-pass) phase, promote internal learning, reduce overdependence on black-box vendors, and align audit logic with clinical evidence.

Attendees will learn how connecting prior authorization and claims data earlier in the care lifecycle can help identify root issues before they become payment errors. Beyond preventing waste, this approach can strengthen provider relationships, improve internal capabilities, and ultimately drive more proactive, accurate decision-making.

Using real-world insights, we’ll show how a collaborative, clinical intelligence-driven model can give payers a sustainable edge in accuracy, agility, and provider trust.

Author:

Monique Pierce

Payment Solutions & Operations

Cohere Health

Monique started her Payment Integrity career in COB at Oxford HealthPlans. After the merger with UnitedHealthcare, she led multiple teams and was responsible for creating innovative programs. Monique joined SCIO Health Analytics in 2014 and was responsible for system and process improvements before being promoted to VP of client engagement and business optimization In 2020, Monique joined start-up Devoted Health and created a full suite of programs from the ground up. Based on a passion for metrics and measuring performance, she centralized and standardized all programs reducing implementation time and maximizing savings. Today, Monique is driving opportunities to improve claim payment by designing and developing new prior auth and claim reconciliation products at Cohere Health.

Author:

Lalithya Yerramilli

SVP, Payment Solutions

Cohere Health

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Drinks Reception | Sponsored by Katch

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Raffaello d'Amor

Head of Product

Magical

Agentic AI or Just Another Bot? Cutting Through the Healthcare Automation Hype

Not all automation is created equal. This session helps healthcare leaders cut through the noise and get real about what “agentic” means in practice. If you’ve been burned by bots that couldn’t scale—or are evaluating solutions now—this talk will help you make smarter choices.

Learning Objectives:

Distinguish between RPA, chatbots, and agentic AI

Learn how agentic systems adapt, escalate, and self-manage

Discover where agentic AI delivers outsized value in RCM

Get a checklist for evaluating automation depth and risk

Author:

Vanessa Moldovan, CRCR, CPC, CPB, CPMA, CPPM, CPC-I

Head of RCM Strategy

Magical

Author:

Raffaello d'Amor

Head of Product

Magical

Read more about Agentic AI or Just Another Bot? Cutting Through the Healthcare Automation Hype

Laika Kayani

Vice President, Product Management, Payment Integrity

Optum

Transforming Payment Integrity through Payment Precision

Payment integrity is at a critical inflection point—facing unprecedented challenges, but also extraordinary opportunity. This session will explore the move from traditional payment integrity to payment precision, focusing on how increased transparency between health plans and providers can enable real-time interactions at claim submission. AI is bringing a new paradigm of payment integrity interventions, and when done right and paired with deep healthcare expertise, it can unlock unprecedented value.