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PAYER INTELLIGENCE HUB

Intelligence organized by the problem on your desk.

Not a content library. Four executive problems, the assets that resolve each, and a route into a quantified review of your own exposure.

FLAGSHIP · AUGUST 2026CY2027 REIMBURSEMENT EXPOSURE

CMS-1850-P: The First Medicare Payment Category for Software as a Medical Service

46 HCPCS codes carry new status indicator O1 effective January 1, 2027. Ten services shift from CLFS to OPPS liability. If the revenue cycle is not remapped before then, the exposure lands as unreimbursed volume.

46 SaMS codes in Table 61/62New status indicator O110 CLFS-to-OPPS liability shiftsRole-based CFO / CMO / UM read

Physician-authored. Vendor-neutral. Cross-referenced against CMS-1850-P and CY2027 Addendum B.

GET THE EXECUTIVE ACTION BRIEF →SEE YOUR ORGANIZATION'S EXPOSURE →

Prevent avoidable denials

Which denial patterns are draining margin before anyone escalates them?

Free · gated

Five Medicare Advantage Denial Patterns Quietly Costing Hospitals 7 Figures

The recurring MA denial mechanics that clear internal audit but never reach the appeal queue.

Free · gated

AI-Driven Denials Now Require Defensible Human-Review Documentation

The 5-element attestation payers must produce — and how to weaponize its absence in appeals.

Quantify reimbursement exposure

What is payer policy drift actually costing this organization in dollars?

$499 · 10-page PDF

CFO Intelligence: 8 Payment Pathways Funding AI in Utilization Management

All 8 pathways ranked, 5-signal risk frame each, 3 quantified scenarios — $56.6M at risk on a 300-bed baseline.

Free · gated

A CFO's One-Page Model for Quantifying Revenue at Risk From Payer Policy Drift

The arithmetic behind the exposure number, in a form a board will accept.

Prepare for policy changes

What lands in CY2027 that the revenue cycle has not been remapped for?

$149 · role-based brief

CMS-1850-P: Role-Based Impact Brief — Software as a Medical Service

46 SaMS codes, new status indicator O1, 10 CLFS-to-OPPS liability shifts effective January 1, 2027.

Free · gated

UnitedHealth Q2 2026: What a $5.5B Profit Means for Hospital Revenue

“Higher provider coding intensity” named as a margin drag — and the four CFO responses it forces.

Assess AI/UM compliance risk

Where does algorithmic utilization review create legal exposure in our states?

Free · gated

The State-by-State AI-in-UM Cheat Sheet

CA SB 1120, IL HB 5395, OK SB 303 and the 2026 wave, mapped to what each statute actually forbids.

Free

PAULA Executive Risk Assessment

Role and facility context in under a minute, then a preliminary exposure profile before any email is requested.

FAQs

Frequently asked questions.

Everything you need to know about PAULA — from how it works to who it's built for.