You can also apply to be the guest on TeqTalk: https://www.teqfocus.com/teqtalks/ You can connect with: Jas Kaur, CTO, Teqfocus: https://www.linkedin.com/in/jas-kaur-5396b237/ Falko Buttler, Chief Technology Officer, Lantern: https://www.linkedin.com/in/falkobuttler/ Paul Risk, VP of Financial Services, Teqfocus: https://www.linkedin.com/in/paulrisk/ ----------- Behind the complexity of medical billing and claims adjudication lies an enormous opportunity to rebuild healthcare payments with data, automation, and AI. In this episode of TeqTalk, Jas Kaur sits down with Falko Buttler (CTO, Lantern) and Paul Risk (VP, Financial Services, Teqfocus) to break down the future of healthcare claims management from faster adjudication and pricing accuracy to transparent reimbursements and modern TPA workflows. We explore how next-generation TPAs like Lantern are transforming the claims lifecycle by: - Reducing claim processing times from 120+ days to just 5.8 days - Using AI, OCR, and automation to streamline claim intake, coding, and pricing - Modernizing the TPA model with outcome-driven, efficiency-focused processes - What a realistic 12-month claims modernization roadmap looks like for payers, TPAs, and employers Timestamps: 00:00 – 00:55 - The $19B Claims Problem & Why AI Matters 00:55 – 02:30 - Guest Introductions 02:30 – 05:15 - What Makes Modern TPAs Different? 05:15 – 07:45 - How the Payer Ecosystem Has Changed 07:45 – 10:20 - Where Claims Slow Down (Transparency, Data, Speed) 10:20 – 12:40 - Why Claim Processing Takes 60–120 Days 12:40 – 14:15 - How Lantern Achieves 5.8-Day Claim Processing 14:15 – 17:00 - Real Patient Story: The Human Cost of Denials 17:00 – 20:00 - The Root Cause: Fragmented, Non-Relational Systems 20:00 – 23:00 - Why Healthcare Needs Standardized Frameworks 23:00 – 26:00 - Price Transparency: Global Comparisons (US vs Germany) 26:00 – 29:00 - How do Hospitals Still Use Legacy Processes (ICD, COBOL, etc.) 29:00 – 31:00 - Unexpected Hospital Bills & Negotiation Realities 31:00 – 34:00 - The Pain of Manual Billing & Delayed Claims 34:00 – 37:00 - Unstructured Data: PDFs, Barcodes & Missing Context 37:00 – 40:00 - How AI + OCR Improve Accuracy in Claim Intake 40:00 – 42:00 - AI’s Value: No Fatigue, No Bias, Consistency 42:00 – 44:00 - Why Good Data Matters More Than Good AI 44:00 – 47:00 - Understanding Claim Denials (Common Causes) 47:00 – 49:00 - Reducing Denials with Identity, Network & Contract Alignment 49:00 – 51:00 - Pricing Models for TPAs: PMPM, Shared Savings & Case Rates 51:00 – 53:20 - The 12-Month Claims Modernization Roadmap 53:20 - The Future: Real-Time Claims & Connected Data If you're involved in healthcare claims, insurance operations, adjudication, TPAs, rev cycle, employer benefits, or health tech, this episode provides an inside look at what’s coming next. ----------- About podcast: TeqTalk is a leading technology podcast hosted by Jas Kaur, focused on the future of AI, data, and digital innovation, especially in healthcare, pharma, and tech space. Each episode features exclusive conversations with CXOs, CIOs, data architects, and industry experts from across the US and Canada. From AI-powered transformation and natural language data access to real-time insights and data integration, TeqTalk explores how modern businesses can bridge the gap between technology and strategy. Whether you're a tech leader, marketer, or innovation enthusiast, TeqTalk delivers practical knowledge, thought leadership, and cutting-edge trends shaping the future of enterprise solutions. Subscribe to stay ahead in the world of artificial intelligence, cloud data platforms, healthcare tech, and business innovation. #gotomarket #ai #genai #teqtalk #Teqfocus #EastBayCXO #salesforce #snowflake #aws #partner #agenticai #datacloud #CIO #technicaldept #healthcare #homehealth #pharma
