Beyond CMS-0057: Unlocking the Full Value of Policy Digitization

Presented by Anterior Health CMS-0057 pushed the industry toward policy digitization - but the more interesting question is what becomes possible once policies are structured with the nuance and context completeness that real clinical reasoning actually requires? In this session, Anterior will explore how getting that foundation right unlocks uses of AI that can reason - not just match rules - across health plan operations. We'll discuss what it means for AI to reason like a clinician rather than a rules engine, how that drives meaningful automation across a range of use cases from prior authorization to payment integrity and beyond, and what a new kind of observability over policy application opens up: insights, consistency analysis, and the ability to model the downstream impact of policy changes before they happen. Plus a demo of Anterior's policy digitization & management product. Presenters: Sam Barber, VP Product Saul Howard, VP Engineering