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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
Panelists

Author:

Melissa McCabe

Payment Integrity Program Lead
Quartz
... read more

Melissa McCabe

Payment Integrity Program Lead
Quartz

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

Moderator

Author:

Steve Yurjevich

CEO, Optum Insight Payer Market
Optum
... read more

Steve Yurjevich

CEO, Optum Insight Payer Market
Optum
Panelists

Author:

Linde Wilton

Senior Director of Operations
Provider Partners Health Plan
... read more

Linde Wilton

Senior Director of Operations
Provider Partners Health Plan

Author:

Diane Nguyen

Senior Project Specialist, Payment Integrity Planning and Implementation
Priority Health
... read more

Diane Nguyen

Senior Project Specialist, Payment Integrity Planning and Implementation
Priority Health

Author:

Neeraj Jaiman

Director of Medical Economics
BCBS NC

Director of Medical Economics with accountability for total cost of care analytics and payment integrity insights across Commercial and Medicare lines of business. Leads advanced analytics to identify key cost drivers, quantify unit cost and utilization trends, and detect payment leakage through contract accuracy, coding, and claims anomaly analysis. Trusted partner to senior leadership on data‑driven strategies that improve affordability, financial performance, and provider accountability. Spearheading the development of payment integrity benchmarks, advanced coding intensity models, and enterprise strategies to mitigate coding intensity through levers such as material change clauses and alternative payment models, including global payments.

... read more

Neeraj Jaiman

Director of Medical Economics
BCBS NC

Director of Medical Economics with accountability for total cost of care analytics and payment integrity insights across Commercial and Medicare lines of business. Leads advanced analytics to identify key cost drivers, quantify unit cost and utilization trends, and detect payment leakage through contract accuracy, coding, and claims anomaly analysis. Trusted partner to senior leadership on data‑driven strategies that improve affordability, financial performance, and provider accountability. Spearheading the development of payment integrity benchmarks, advanced coding intensity models, and enterprise strategies to mitigate coding intensity through levers such as material change clauses and alternative payment models, including global payments.

Author:

Corella Lumpkins

President-Elect
AAPC National Advisory Board

Corella Lumpkins is the Manager of Coding, Compliance & Provider Education at Loudoun Medical Group (LMG) - one of the largest and most diverse physician-owned, multi-specialty Accountable Care Organizations in Northern Virginia/DC suburbs. As a subject matter expert, Corella has over 35 years of experience working in every area of the healthcare revenue cycle. Corella holds a bachelor’s degree and eleven certifications with an extensive background in auditing, billing, coding, implementing corporate compliance programs, CDI, education, denial and practice management. Prior to joining LMG, Corella has held leadership roles at Lifebridge, Medstar, Johns Hopkins and the University of Maryland health systems.

Corella is an author, adjunct faculty member and national speaker currently serving on both the AAPC National Advisory Board and Association of Clinical Documentation Integrity Specialists (ACDIS) Leadership Council. Corella works closely with providers in navigating patient-centric value-based care. 

... read more

Corella Lumpkins

President-Elect
AAPC National Advisory Board

Corella Lumpkins is the Manager of Coding, Compliance & Provider Education at Loudoun Medical Group (LMG) - one of the largest and most diverse physician-owned, multi-specialty Accountable Care Organizations in Northern Virginia/DC suburbs. As a subject matter expert, Corella has over 35 years of experience working in every area of the healthcare revenue cycle. Corella holds a bachelor’s degree and eleven certifications with an extensive background in auditing, billing, coding, implementing corporate compliance programs, CDI, education, denial and practice management. Prior to joining LMG, Corella has held leadership roles at Lifebridge, Medstar, Johns Hopkins and the University of Maryland health systems.

Corella is an author, adjunct faculty member and national speaker currently serving on both the AAPC National Advisory Board and Association of Clinical Documentation Integrity Specialists (ACDIS) Leadership Council. Corella works closely with providers in navigating patient-centric value-based care. 

Author:

Barbara Shaw

Clinical Review Specialist
Mass General Brigham
... read more

Barbara Shaw

Clinical Review Specialist
Mass General Brigham

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

Author:

Ankur Verma

Vice President
Everest Group

Ankur Verma is a member of the Business Process Services team and assists clients on topics related to optimizing business process service delivery models, with an emphasis on Healthcare (payers and providers) and Life Sciences. Ankur’s responsibilities include assisting in managing Everest Group’s Healthcare and Life Sciences Outsourcing subscription offerings and providing outsourcing advisory services to clients on an ad hoc basis.

Prior to joining Everest Group, Ankur was a Senior Analyst with The Smartcube. He holds a bachelor’s degree in technology from Netaji Subhas Institute of Technology, Delhi.

... read more

Ankur Verma

Vice President
Everest Group

Ankur Verma is a member of the Business Process Services team and assists clients on topics related to optimizing business process service delivery models, with an emphasis on Healthcare (payers and providers) and Life Sciences. Ankur’s responsibilities include assisting in managing Everest Group’s Healthcare and Life Sciences Outsourcing subscription offerings and providing outsourcing advisory services to clients on an ad hoc basis.

Prior to joining Everest Group, Ankur was a Senior Analyst with The Smartcube. He holds a bachelor’s degree in technology from Netaji Subhas Institute of Technology, Delhi.

Author:

Suyash Choudhary

Senior Analyst
Everest Group
... read more

Suyash Choudhary

Senior Analyst
Everest Group

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
Moderator

Author:

Natalie Clayton

Head of Market Intelligence
Kisaco Research
... read more

Natalie Clayton

Head of Market Intelligence
Kisaco Research
 

Darshak Sanghavi

Chief Medical Officer
Machinify

Darshak Sanghavi, MD, is Chief Medical Officer of Machinify.

Read full bio

Darshak Sanghavi

Chief Medical Officer
Machinify

Darshak Sanghavi

Chief Medical Officer
Machinify

Darshak Sanghavi, MD, is Chief Medical Officer of Machinify.

Recently, he was one of the first Program Managers at the Advanced Research Projects Agency for Health (ARPA-H), a new multibillion dollar U.S. agency that the President tasked with developing health programs “so bold no one else, not even the private sector, is willing to give them a chance.” Overseeing an investment portfolio of several hundred million dollars, his programs cover cures for rare genetic diseases, regenerative medicine, women’s health, organ transplantation, innovative payment and business models for prevention, and many other areas.

Prior, he was Global Chief Medical and Clinical Operating Officer for Babylon, the global end-to-end digital health care provider serving over a dozen countries and over 24 million people, with the mission of bringing “affordable and accessible health care to everyone on Earth.” He was a member of the senior leadership team taking the company public in 2021 and oversaw a team of 1500 in the company’s global operations in the United States, United Kingdom, and Rwanda with revenues exceeding $1B. He is the former Chief Medical Officer of UnitedHealthcare’s Medicare & Retirement, the largest U.S. commercial Medicare program with over $90B in annual revenue, where he directed major national clinical and affordability programs. Earlier, he was Chief Medical Officer at OptumLabs, the R&D hub of UnitedHealth Group, running a portfolio of industry-leading projects with dozens of academic, government, and industry partners.

Before then, he served in a senior role in the federal government, as the Director of Preventive and Population Health at the Center for Medicare and Medicaid Innovation, where he directed the development of large pilot programs aimed at improving the nation’s health care costs and quality. In this capacity, he was the architect of the Accountable Health Communities model, the Million Hearts Cardiovascular Risk Reduction model, and the Medicare Diabetes Prevention Program, impacting tens of millions of Medicare beneficiaries. He was a fellow and managing director of the non-partisan Brookings Institution, and chief of pediatric cardiology at UMass Medical School (where he still sees patients). He’s an award-winning medical educator, has worked around the world and published dozens of scientific papers on topics ranging from the molecular biology of cell death to tuberculosis transmission in Peruvian slums.

A frequent guest on NBC’s Today and past commentator for NPR’s All Things Considered, Dr. Sanghavi was a columnist with Slate, the New York Times, Boston Globe, and Washington Post. His best-seller, A Map of the Child: A Pediatrician’s Tour of the Body, was named a best health book of the year by the Wall Street Journal. He previously worked as a U.S. Indian Health Service pediatrician on a Navajo reservation.

Educated at Harvard and Johns Hopkins, he completed his residency in pediatrics and fellowship in pediatric cardiology at Boston Children’s Hospital.