Inside Medicare's Invisible Backbone: Claims Processing, AI Innovation, and the $500 Billion System Written in COBOL
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Inside Medicare's Invisible Backbone: Claims Processing, AI Innovation, and the $500 Billion System Written in COBOL
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Brian Janssen reflects on running Medicare operations at WPS Health Solutions, processing 130+ million claims annually through an infrastructure that many healthcare professionals don't know exists. He shares why MACs are "the largest backbone of processing in the country that the healthcare world doesn't really know about," how regional variation matters when Flint, Michigan's environmental crisis affects local coverage decisions differently than in rural Kansas, and the challenge of innovating with AI while maintaining FISMA High security in physical data centers in systems that can't afford a single day of payment disruption.
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