Healthesystems representatives attended the IAIABC Forum alongside regulators and industry stakeholders for discussions on evolving approaches to carrier compliance and oversight, reflecting an increasing shift toward data driven, audit intensive oversight emphasizing timeliness, accuracy, transparency, and system alignment.

Key discussion themes included:

• Data Driven, High Volume Oversight: Regulators are increasingly relying on large scale electronic data reviews, such as medical billing, EDI transactions, and claims timeliness, rather than isolated claim audits
• Structured and Rigorous Audits: Audit programs follow standardized lifecycles, with defined claim samples and corrective actions expected to address root causes
• Education and Collaboration: Training, regulator led education, and stakeholder collaboration were emphasized as key to reducing operational compliance risk
• Multi State Claims Complexity: Regulators highlighted ongoing misalignment between national claims operations and evolving state specific requirements, increasing system level compliance risk
• Technology Supporting Governance: Analytics and AI are viewed as valuable tools, but regulators stressed that automation must remain transparent, auditable, and aligned with regulatory intent

For the management of complex, multi-state claims operations, these discussions underscore the growing importance of strong compliance support as oversight becomes more data driven and audit focused. Forums like IAIABC enable collaboration with regulators and industry experts to better understand evolving expectations that directly affect compliance outcomes.