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

Providers are quickly integrating AI into their documentation, coding, and appeals workflows. Plans are using AI to flag anomalies, automate review, and catch coding errors at scale. Many plans perceive provider AI use as a negative force driving more coding intensity and upcoding. But how can AI use by payers and providers be reframed to drive real-time, accurate claims adjudication that saves costs on both sides? This panel discussion brings together leaders from both perspectives to brainstorm collaboration strategies.

• 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 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