Payers and providers sign one contract. Then each builds separate software to interpret it. Two codebases. Two answers. That gap is where denials live.
The industry response: buy better AI. Providers use it to fight denials. Payers use it to generate them. Both sides get better weapons. The battlefield never changes.
This is a coordination problem, not a tech problem. Card networks solved it for payments. Central counterparties solved it for securities. Healthcare reimbursement has the same structural signature.
The fix is a neutral exchange where both sides pre-approve one executable version of their contract and agree the output is the correct payment. Sell finality, not a better calculator.
Subscribe to www.onhealthcare.tech for free and paid articles, podcasts, and more.
