Every payment integrity recovery, denial, and appeal eventually comes back to one place: the clinical documentation in the medical record. For payer PI teams that are still building out or scaling up, understanding how documentation is created, queried, and finalised before it ever reaches a claim is the single most useful foundation you can lay. RCX works on both sides of that fence, supporting hospital CDI programs and payer DRG validation reviews, and this panel brings together payer PI leaders and clinical documentation experts who have spent their careers inside the chart. The goal: help attendees build review programs that recover real dollars, hold up under appeal, and don't burn out their provider relationships in the process.

• How clinical documentation actually gets created, queried, and finalised on the provider side, and the DRG families where new PI programs should focus first
• What "defensible" looks like in a DRG validation or documentation-driven review, and how to design reviews that recover dollars without destroying provider relationships
• Where AI fits for a team just starting out, and what data and governance you need before turning it on

In partnership with RevCycle Xperts

AI is now a practical operating priority for health plans. The biggest questions are no longer about whether AI can create value, but which use cases are working, how to govern them responsibly, and how to move from pilots to measurable performance.
This workshop will feature health plans of different sizes and leaders from across the payment integrity spectrum. Together, they will share real-world AI applications across claims review, fraud detection, documentation intelligence, provider engagement, anomaly detection, and pre-pay cost avoidance. The session will begin with health plan case studies, followed by an interactive audience Q&A panel where payer leaders will share lessons on what is working, where challenges remain, and what it takes to scale AI safely and defensibly.
Takeaways

• Pinpoint where AI is already delivering value across payment integrity workflows
• Understand what needs to be in place to scale AI responsibly and defensibly
• Learn how health plans are managing automation alongside provider relationships, regulatory pressure, and ROI expectations

This closing panel brings together payment integrity leaders for a candid conversation about the insights and hard-won wisdom that have shaped their programs. Panelists will share what they have learned from the journey so far — the pivots that paid off, the decisions they would approach differently with hindsight, and how they are positioning their programs for the rest of 2026 and into 2027. The discussion will also turn forward: if you were building a PI program from the ground up today, what would it look like? Attendees can expect to walk away with actionable insights and real takeaways to apply to their own PI programs.

• The pivotal moments and turning points that shaped how PI leaders think today
• What leaders know now that they wish they had known when building their programs
• Is the future of affordability "no PI" or "no claims"?
• What the room should start doing, stop doing, or think about differently within PI operations

We’ve all seen the AI “arms race” headlines—but the adoption of AI shouldn’t widen the gap between payers and providers. It should help bring the two sides closer together. As payers and providers rapidly adopt AI across workflows, the bigger opportunity is building more connected strategies that improve accuracy and drive affordability. This panel discussion brings together leaders from both perspectives to brainstorm collaboration strategies and explore how AI can help support real-time, accurate claims adjudication and ultimately help create more seamless experiences across healthcare.

• Provider perspective: The impact of AI tools on claims accuracy and ‘coding intensity’
• Payer perspective: The impact of AI tools on provider relationships, communications, and perspectives on ‘coding intensity’
• How AI can be leveraged to enable collaboration and real-time claims adjudication

In partnership with Optum

In this interactive workshop, plan leaders will share best practices regarding key trends and challenges facing COB, including:

• The latest trends and policy updates impacting COB
• Implications of Federal Medicaid cuts on COB, eligibility, and overpayments
• AI-assisted eligibility tools and other opportunities to leverage AI for COB effectiveness

Payment integrity is undergoing a structural reset. Plans are moving from retrospective "pay and chase" audits to pre-payment validation powered by AI, predictive analytics, and automation. The vendor landscape is fragmenting in parallel; specialist innovators are challenging established leaders, while payers rethink whether to insource, outsource, or co-source across claims editing, clinical review, COB, subrogation, and FWA. But how should payer leaders sequence technology, services, and operating-model decisions to lower MLR and reduce provider abrasion without disrupting throughput? This two-speaker session unpacks where the PI market is heading and how plans should position for what's next.

• How AI and pre-payment validation are shifting value from recovery to prevention
• How niche innovators are reshaping vendor selection and the case for unified pre-pay / post-pay platforms
• How payers are restructuring in-house, outsourced, and co-sourced PI to make payment accuracy a strategic advantage

In this session, the Working Group shares the first exclusive savings PMPM benchmarks, including insight on methodology, process, outcomes, and plans moving forward. Attendees will share feedback and recommendations for the next iterations of benchmarks. The session will include breakout roundtables focused on best practices to exceed benchmarks by PI program and line of business.

• Presentation of baseline savings PMPM benchmarks
• Audience feedback on next benchmark iterations
• Breakout roundtable discussions focused on achieving benchmarks by PI program