Artificial intelligence (AI) is rapidly transforming hospital operations, from diagnostics and documentation to revenue cycle management. As these tools grow more powerful and pervasive, they are reshaping how care is delivered, documented, and billed. For health plan leaders, this new era introduces both enormous potential and significant risk. AI may streamline care, reduce waste and optimize workflows. But left unchecked, it could also be used to inflate billing, obscure audit trails, and push utilization into more expensive settings.

AI use cases

Hospitals and health systems are deploying AI across clinical, operational, and financial domains. On the clinical side, AI is being used to interpret radiology images, support diagnoses, and personalize treatment plans. Operationally, AI-po

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