The healthcare industry faces a transformative moment because Agile methods together with automation technology will transform Medicare and Medicaid claims processing and bring improvements to patient results. The existing healthcare processing systems face ongoing obstacles which include errors in outputs while taking too much time to process procedures as well as demanding HIPAA compliance rules. Through integration of Agile principles with AI and RPA and blockchain and IoT platforms the healthcare industry attains operation improvements along with cost reductions and better patient experiences in care delivery. Agile healthcare development moves toward automation in claims processing with its effects on patient results as a primary focus. This paper analyses newly emerging technologies plus implementation methods while studying difficulties and practical case studies by using best examples of practice. Healthcare organizations use Agile methods with automation to drive operational superiority and stronger healthcare results and better conformity to regulations.

Agile Methodologies, Claims Processing, Automation, Medicare, Medicaid, HIPAA Compliance, Artificial Intelligence

Anderson, D. J. (2010). Kanban: Successful Evolutionary Change for Your Technology Business. Blue Hole Press.

Centers for Medicare & Medicaid Services. (2022). 2022 Medicare Fee-for-Service Improper Payment Report. Retrieved from https://www.cms.gov.

Highsmith, J. (2010). Agile Project Management: Creating Innovative Products. Boston: Addison-Wesley.

Johnson, K., Lee, S., & Brown, T. (2021). Blockchain applications in healthcare data security. Journal of Healthcare Informatics, 12(3), 78–89.

Lee, C., et al. (2021). Machine Learning Applications in Supply Chain Forecasting. Journal of Supply Chain Management, 57(2), 45–60.

McDonald, R., Waring, J., & Bishop, S. (2018). Process redesign in healthcare: Lessons from Lean and Agile. Health Services Management Research, 31(4), 196–205.

Patel, V., Chesnokova, A., & Lee, H. (2020). Automation in healthcare claims processing: Opportunities and challenges. Healthcare Policy Journal, 15(2), 34–45.

Sanders, N. R. (2018). Supply Chain Management: A Global Perspective (2nd ed.). Wiley.

Schwaber, K., & Sutherland, J. (2020). The Scrum Guide. Retrieved from https://www.scrumguides.org.

Smith, J., & Jones, M. (2019). Robotic process automation in healthcare: Efficiency and error reduction. Journal of Health Information Management, 10(4), 101–112.

U.S. Department of Health and Human Services. (2023). HIPAA Enforcement. Retrieved from https://www.hhs.gov/hipaa.

Womack, J. P., & Jones, D. T. (2003). Lean Thinking: Banish Waste and Create Wealth in Your Corporation. New York: Free Press.