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

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 discussion provides an candid insight from payment integrity eaders from across the room as share what they have learned from programmes that did not go to plan, decisions they would make differently how they plan to move ahead for the rest of 026 and into 2027. Attendees can expect to walk away with actionable insights and real takeaways that can be implemented into their own PI programs.

- What a programme failure or mis-step taught a PI leaders something that success never would have
- What leaders know now that they wish they had known when they were building their programmes
- What the rest of the room should stop doing, start doing, or think about differently within their 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 session, the Working Group shares the first exclusive savings PMPM benchmarks, including insight on methodology, process, outcomes, and plans moving forward. Attendees will share feedback and recommendations for the next iterations of benchmarks. The session will include breakout roundtables focused on best practices to exceed benchmarks by PI program and line of business.
- Presentation of baseline savings PMPM benchmarks
- Audience feedback on next benchmark iterations
- Breakout roundtable discussions focused on achieving benchmarks by PI program