Code updates. Site-of-service rule changes. Specialty drug billing classifications. Telehealth policy still being written. Coding technology evolving. The environment that edit programs have to keep up with in 2026 is more complex than it has ever been, and an annual review cycle is not enough. This session looks at what a well-governed, modern, continuously maintained edit program looks like in practice, where the most costly gaps tend to open and how technology can keep your plan ahead.
- How to build an edit governance process that keeps pace with frequent policy changes across multiple lines of business
- Where the highest-risk edit gaps are opening right now and how to prioritise closing them without expanding every programme at once
- How to defend edits in provider disputes when the underlying policy they are based on is itself in transition
In partnership with Shift Technology
Jesse Montgomery
Leading Healthcare Customer Success and Value Engineering, my mission has been focused on transforming customer engagement through a fusion of industry knowledge, data science, and personalized service strategies. Leverage my strategic partnerships to advance collaborative successes, resulting in the development of creative and innovative healthcare solutions and capability expansion for Shift Technology focused on payment integrity, ultimately enhancing our customer commitments and financial targets.
Dr. Priscilla Alfaro
Dr. Priscilla Alfaro is a seasoned healthcare professional with extensive experience in executive medical management, fraud prevention, and healthcare analytics. A certified medical coder, fraud examiner, and auditor, she has a proven track record of improving healthcare efficiency and preventing fraud, waste, and abuse across various roles and affiliations, including the Texas HHS and Anthem.