The Transformation to Real-Time Intelligence: How Clinical Data, AI, and New PI Capabilities are Accelerating the Pre-Pay Shift | Kisaco Research
Clinical data is becoming the foundation that enables payment integrity to evolve from payment recovery to prevention, impacting payment accuracy and broader healthcare affordability goals. But this shift requires transforming how clinical data, AI, PI processes and people are aligned. Through a case study example, payment integrity and clinical data leaders from BCBS of South Carolina will discuss an innovative approach to using real-time clinical data to generate their own ‘claims’ to guide pre-payment reviews. Key topics will include:
  • Developing a roadmap for effective clinical data integration into pre-pay PI decision making and workflows
  • Reimagining the PI process – new capabilities, collaboration, and upscaling staff
  • Lessons learned while shifting from traditional post-pay operations and governance

In partnership with Claritev

Speaker(s): 
Moderator

Author:

Marla Ludacka-Dragovich

Vice President of Payment Integrity Operations
Claritev

Marla Ludacka-Dragovich is Vice President of Payment Integrity Operations at Claritev, where she leads Payment & Revenue Integrity Services both Pre- and Post-Payment. Her leadership spans Advanced Code Editing, Itemized Bill Review, DRG Validation, Specialty Services, Coordination of Benefits, Data Mining, End Stage Renal Disease, and Medicare Secondary Payer programs. She also supports Clinical Negotiations and drives innovation across manual code editing, analytics, and product development.

With more than 25 years of healthcare experience, primarily within the Blue Cross and Blue Shield system, Marla brings deep expertise in network operations and payment integrity. She is passionate about advancing innovative solutions, improving operational performance, and delivering meaningful value across the healthcare ecosystem. Marla holds a Bachelor of Science in Finance and Economics from Elmhurst University.

Outside of work, Marla enjoys boating, golfing, biking, hiking, tennis, pickleball, and reading, and is the proud mother of two sons.

Marla Ludacka-Dragovich

Vice President of Payment Integrity Operations
Claritev

Marla Ludacka-Dragovich is Vice President of Payment Integrity Operations at Claritev, where she leads Payment & Revenue Integrity Services both Pre- and Post-Payment. Her leadership spans Advanced Code Editing, Itemized Bill Review, DRG Validation, Specialty Services, Coordination of Benefits, Data Mining, End Stage Renal Disease, and Medicare Secondary Payer programs. She also supports Clinical Negotiations and drives innovation across manual code editing, analytics, and product development.

With more than 25 years of healthcare experience, primarily within the Blue Cross and Blue Shield system, Marla brings deep expertise in network operations and payment integrity. She is passionate about advancing innovative solutions, improving operational performance, and delivering meaningful value across the healthcare ecosystem. Marla holds a Bachelor of Science in Finance and Economics from Elmhurst University.

Outside of work, Marla enjoys boating, golfing, biking, hiking, tennis, pickleball, and reading, and is the proud mother of two sons.

Panelists

Author:

Karen S. Campbell

Senior Director, Payment Integrity, Payor Innovations Division
BlueCross BlueShield of South Carolina

Karen Campbell is Senior Director for Payment Integrity at BlueCross BlueShield of South Carolina. She has been part of Payment Integrity team since early inception and helped develop core team capabilities from data mining to policy application and clinical support. Her recent focus has been on solution deployment that expands system edits, provider education and increases clinical claim reviews both pre-pay and post-pay.  She has worked closely with Operations, Decision Support and Medical Affairs to help take new policies, technology and edits from inception to deployment throughout the organization.

Karen S. Campbell

Senior Director, Payment Integrity, Payor Innovations Division
BlueCross BlueShield of South Carolina

Karen Campbell is Senior Director for Payment Integrity at BlueCross BlueShield of South Carolina. She has been part of Payment Integrity team since early inception and helped develop core team capabilities from data mining to policy application and clinical support. Her recent focus has been on solution deployment that expands system edits, provider education and increases clinical claim reviews both pre-pay and post-pay.  She has worked closely with Operations, Decision Support and Medical Affairs to help take new policies, technology and edits from inception to deployment throughout the organization.

Author:

Autumne Smith

Director, Connected Health Services
BlueCross BlueShield of South Carolina
Autumne Smith is the Director of Connected Health Services at BlueCross BlueShield of South Carolina, where she leads enterprise initiatives focused on interoperability, clinical data exchange, regulatory readiness, and connected health innovation. With more than 10 years of experience across health care data, technology, governance, and operations, Autumne brings together business strategy, technical execution, and compliance rigor to advance how health information is exchanged, governed, and used to improve outcomes.
Autumne earned her Master’s in Health Information Technology from the University of South Carolina and her Bachelor of Art in Psychology from Winthrop University.

Autumne Smith

Director, Connected Health Services
BlueCross BlueShield of South Carolina
Autumne Smith is the Director of Connected Health Services at BlueCross BlueShield of South Carolina, where she leads enterprise initiatives focused on interoperability, clinical data exchange, regulatory readiness, and connected health innovation. With more than 10 years of experience across health care data, technology, governance, and operations, Autumne brings together business strategy, technical execution, and compliance rigor to advance how health information is exchanged, governed, and used to improve outcomes.
Autumne earned her Master’s in Health Information Technology from the University of South Carolina and her Bachelor of Art in Psychology from Winthrop University.
Time: 
4:15pm
Agenda Track No.: 
Track 2
Session Type: 
Panel
Force Inline Description: 
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