Every missing or outdated edit is a window of exposure for plans, and foundational gaps in a plan's edit program are more common than most realize. Identifying and locking down that exposure is crucial, but the speed of action makes a major difference in downstream impact.
Accelerating time-to-value for a large regional health plan
When Shift conducted a risk assessment for a large regional health plan, the findings were immediate. The plan did not have foundational claim edits in place, and outpatient overpayments continued to rise. Using generative AI to quickly ingest and transform CMS source files into edits tailored to plan needs, Shift closed the gap fast:
- Risk assessment identified the exposure within days
- Agents and generative AI transformed large volumes of CMS files into production-ready logic
- Edits were built, tested, and deployed in under four days, resulting in immediate savings
To hear more about how Shift leveraged agents and generative AI to deploy open source edits and deliver fast impact for a regional health plan, watch Shift's Sr. Product Manager for U.S. Health, Mark Starinsky, in the video below.
