Healthcare institutions experience major operational issues while handling Medicare and Medicaid claims because they must meet strict HIPAA security standards. The waterfall model method together with traditional approaches leads to various delays along with multiple errors in addition to different compliance risks because of its strict framework. The iterative collaborative adaptive framework of Agile methodologies provides healthcare organizations with a solution to optimize processing claims and minimize operational problems while maintaining HIPAA standards. Agile principles serve as the basis for this paper which investigates methods to enhance Medicare and Medicaid claims processing systems. The paper investigates existing claims processing challenges before exploring how Agile transformations work while providing strategies to keep HIPAA compliance active inside Agile organizations. This paper uses case studies and best practices with future analysis to show how Agile transforms claims processing in healthcare though protecting patient information.

Agile Methodologies, Medicare, Medicaid, Claims Processing, HIPAA Compliance

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