Canada

The numbers on both sides reflect the amount at play. UnitedHealth Group projects AI could save it nearly $1 billion in 2026, while HCA Healthcare expects roughly $400 million in AI-driven cost savings, partly from automating revenue management, according to Reuters. On the other side of that ledger, Blue Cross Blue Shield has released an analysis suggesting that AI-enabled coding practices may be responsible for more than $2 billion in additional claims spending nationwide.

Hospitals Use AI to Optimize Billing

Hospitals are turning to AI to automate clinical documentation and medical coding, the process of translating care into standardized billing codes submitted to insurers. These tools use ambient listening technology to capture clinical interactions in real time, then analyze physician notes and lab reports to automatically assign billing codes, a workflow that proponents say reduces paperwork and physician burnout.

But the Blue Cross Blue Shield Association analysis of de-identified claims data found patterns that raise questions about accuracy. Researchers tracked a sharp rise in diagnoses of acute posthemorrhagic anemia at hospitals that had publicly disclosed AI adoption. In many of these cases, patients coded with the condition never received blood transfusions, a treatment typically associated with it. That diagnosis spike alone added $22 million to maternity admission costs in one year.

Looking across all facilities, the analysis attributed about $663 million in inpatient spending and at least $1.67 billion in outpatient spending to AI-powered coding practices.

Federal data shows 7 in 10 U.S. hospitals used predictive AI in 2024, with AI use for billing jumping 25% year over year, according to U.S. News and World Report.

Insurers Use Their Own Algorithms

As hospitals automate revenue capture, insurers are deploying AI to audit claims and deny coverage at scale. The share of provider claims denied more than 10% of the time has risen from 30% three years ago to 41% today, according to Experian. Insurers on Affordable Care Act marketplaces denied nearly 1 in 5 in-network claims in 2023, up from 17% in 2021, according to KFF.

UnitedHealth Group has faced scrutiny from federal lawmakers over its use of algorithms to deny care to seniors enrolled in Medicare Advantage, according to industry news site Stat. Humana and other insurers face lawsuits and regulatory investigations over similar practices, said Revenue Cycle Coding Strategies. The industry argues AI improves efficiency and reduces costs by processing high volumes of claims data that would otherwise require extensive manual review.

Patients are beginning to arm themselves with AI tools as well, according to North Carolina Health News. Startups, including Sheer Health and the nonprofit Counterforce Health, have built tools that help patients analyze denial letters, cross-reference their insurance policies and draft appeals. Historically, fewer than 1% of denied claims are appealed, and patients lose more than half of those appeals.

Consumer AI tools are designed to shift that math, though Carmel Shachar, assistant clinical professor of law and the faculty director of the Health Law and Policy Clinic at Harvard Law School, warned that it can be difficult for a layperson to understand when AI is doing good work and when it is hallucinating or giving something that isn’t quite accurate, according to North Carolina Health News.

Regulation Meets Rapidly Scaling Problem

The speed of AI deployment on both sides of the healthcare billing divide is outpacing regulatory frameworks. The site said more than a dozen states passed laws regulating AI in healthcare in 2025, with Arizona, Maryland, Nebraska and Texas among those banning AI as the sole decision-maker in prior authorization denials. Broader federal standards have not kept pace.

The concern for regulators is not simply that AI speeds up billing disputes. It is that automated systems on both sides risk optimizing for financial outcomes rather than clinical accuracy, with patients caught between competing algorithms.

Digital payments innovation rarely advances in lockstep, and the divergence is becoming more pronounced as regulation, technological readiness and consumer habits pull markets along distinct trajectories.

Speaking with PYMNTS TV, Arjen Hollander, VP of Strategic Partnerships at Thales, described a global payments landscape defined by local realities.

“Innovation is really where three forces, regulation, technology and consumer habits intersect,” he said.

The consequence for issuers is a persistent tension: Customers expect uniform digital experiences, while the conditions shaping those experiences vary sharply across regions.

Expectations Converge Faster Than Markets

Consumer behavior is arguably the most unpredictable. Payments are deeply cultural, and habits vary widely even between neighboring markets, even if from the consumer’s vantage point, payments appear borderless. Hollander noted that “payments feel global,” reflecting decades of coordination by card networks that made credentials widely accepted. Yet beneath that apparent consistency lies substantial fragmentation.

Wallet adoption, Hollander said, is one of the clearest signals that consumer expectations are shifting to instant provisioning, seamless checkout and uninterrupted authorization regardless of geography, device or channel.

“When we see Apple Pay and Google Pay being enabled for a market, we almost always see all other digital payment technologies accelerate,” he told PYMNTS.

In practice, wallets serve as catalysts, moving digital issuance and tokenization from experimental initiatives into core priorities. As customers grow accustomed to immediate, friction-light interactions, issuers face mounting pressure to deliver reliability not only within their own apps but across third-party ecosystems.

Winning Globally, Thinking Locally

Despite the perception of global payments uniformity, Hollander said expansion remains deeply localized. Issuers must navigate regulation — licensing frameworks, BIN rules, KYC obligations and data regulations — market by market as they introduce structural constraints that directly influence cost, timelines and product design.

Issuers that move into markets effectively, Hollander said, adopt a dual strategy: global technology platform standardization combined with targeted local adaptation. They only localize components where truly necessary. Unified issuance stacks, life cycle management and tokenization capabilities can provide consistency and efficiency, while regional compliance and fulfillment layers absorb local complexity.

As an example, he pointed to Thales helping banks and FinTechs deploy standardized digital and physical issuance, tokenization and life cycle management capabilities for them that can be adapted for local regulatory and infrastructure requirements. The company’s approach emphasizes modular technology stacks while maintaining a cohesive global platform.

Europe Illustrates Regulations’ Structural Impact

Europe illustrates how regulation can become a strategic driver of innovation rather than a pure compliance exercise. Hollander described PSD2 as “a significant turning point” that “changed the mindset of the banks,” particularly around openness and API-driven collaboration. Passporting rules, which allow firms to operate across multiple markets under a single license, represent what he called a “huge structural advantage.”

Regulatory decisions affecting NFC access and wallet competition are similarly recalibrating issuer strategies. Rather than serving as compliance exercises alone, these measures influence product design, competitive positioning and partnership models. Issuers must now evaluate wallet enablement as a strategic dimension of customer engagement.

These regulatory dynamics also interact with varying levels of technology maturity across regions. For example, some Latin American issuers, he observed, have built cloud-native stacks capable of rapid adoption, while certain European institutions operate highly reliable but older cores that complicate modernization.

Competition Is Shifting Toward Share of Wallet

Taken together, these regulatory shifts shape how issuers deploy new capabilities across Europe. But even when regulation accelerates innovation, the decisive force ultimately becomes consumer behavior — especially in markets where wallets dominate the payment experience.

In wallet-centric markets, the competitive battleground increasingly resides within digital interfaces controlled by third parties. Hollander recounted his experience living in Guangzhou, China, where he “wasn’t paying with my bank anymore, I was paying with the app.” And no matter the setting or locale, even minor frictions, such as slower authorization or cumbersome provisioning, can trigger immediate credential switching. “Consumers just switch their cards, but they stay loyal to the wallet,” he said.

Wallets, in this view, function less as payment instruments than as primary customer interfaces. Issuers must therefore optimize performance, user experience and reliability beyond their own environments.

Wallets Provide Infrastructure, Not the End State

Wallets, therefore, reflect both consumer expectations and the underlying technological readiness required to support instant, seamless interactions.

While wallets accelerate adoption, Hollander characterized them as foundational rather than final. The technologies used by wallets establish the foundation on which new commerce experiences — such as Click to Pay and payment passkeys — can scale rapidly once consumers are accustomed to instant, wallet‑driven interactions. Standardized digital issuance, tokenization and life cycle management become prerequisites for participation.

Even in digitally advanced ecosystems, digital journeys meet a physical layer — cards — and that layer remains deeply local. Card manufacturing, personalization and delivery retain localized dependencies tied to logistics and customs. Maintaining consistent customer experiences requires coordination across both digital and physical layers.

Security Strategies Must Adapt Regionally

Just as can be seen with innovation, fraud patterns, Hollander stressed, are not uniform. Copying a security setup from one region to another can actually backfire, he warned.

Increasingly, issuers are adopting adaptive, risk-based models that determine when to step up authentication and when to remain invisible. Technologies such as tokenization and payment passkeys strengthen protection while minimizing disruption.

“The goal is not maximum security at all times. It’s the right amount of security,” Hollander said.

Interoperability Remains a Persistent Constraint

Interoperability, though often taken for granted by consumers, continues to challenge issuers operating across markets. Even when standards exist, their implementations often diverge. Hollander cited variations in Click to Pay deployments as an example of how nominal standardization can still generate operational complexity, each scheme designing the solution with varied implementations.

Looking ahead, emerging credentials and commerce models are likely to intensify these demands. Alignment across APIs, data formats and security frameworks will remain central to scaling efforts.

As Hollander summarized, the payments industry’s dynamism shows little sign of slowing.

For issuers, success hinges on one discipline: global standardization where possible, and precise local adaptation where required. “Although we are global, that local component is key,” he said.

Canada’s payments landscape is being recast at high speed, and the once-predictable routines of corporate treasurers are being pushed into the digital fast lane.

The change is as much cultural as technological for the practitioners who sit at the center of cash management.

“I have been on the ground here in Canada … for over 25 years,” Lyndsay Langford, Bank of America’s head of Global Payment Solutions for Canada, told PYMNTS. “In the past, we had wires, EFT and checks. Today, clients demand faster payments, less friction and richer remittance data.”

Those demands have forced treasury teams to abandon manual processes and build real-time visibility into positions and forecasts. The pandemic “shifted us toward a more digital mindset,” accelerating projects that once sat on multiyear road maps, she said.

That shift is playing out against a sweeping upgrade of Canada’s underlying rails. Payments Canada began its modernization plan in 2016, replacing the legacy wire system with Lynx and preparing the country’s first real-time rail (RTR).

“We’re heavily focused right now as a country on the buildout and the launch of real-time payments,” Langford said.

Once live, RTR will settle payments in seconds, carry data-rich messages and eventually enable QR-code requests for payment and cross-border links to other real-time payment methods. Interac — once a person-to-person tool — now supports near-instant business-to-consumer disbursements. Two years ago, Bank of America folded the channel into its global digital disbursements platform alongside Zelle and PayPal.

The glue that makes many of those ambitions useful to a treasurer is ISO 20022, a global messaging standard that expands the amount of information that can travel with each transaction. Bank of America has been running a formal ISO migration program since 2019 and has already completed “over 10 clearing migrations around the world,” Langford said.

Early Canadian adopters are exploiting the richer data to “remove a lot of manual work from the reconciliation process,” she said because ERP systems can auto-match invoices to payments the moment funds hit. The bank is building direct ISO feeds into corporate accounting platforms to maximize straight-through processing.

Risk Mitigation

Yet data alone does not erase the uncertainty of sending money across borders. Pandemic shocks, geopolitical tension and exchange rate swings have only amplified that uncertainty.

“Risk mitigation for cross-border payments is rising to the top of the priority list,” Langford said.

Bank of America’s answer includes a guaranteed foreign exchange (FX) rate solution that allows clients to lock in an FX rate for up to a year — “market leading” in tenor, she said — and CashPro Forecasting, a machine learning tool that predicts liquidity needs so companies can “make more intelligent working capital decisions” and pivot when volatility strikes.

Speed, meanwhile, is not always paramount.

“We want to make sure the options we put in front of clients are cost‑effective and fast where speed is important,” Langford said.

Still, the bank also aims for a globally consistent user experience so a Canadian treasurer responsible for Asia or Europe sees the same interface and controls.

Much of that experience is delivered through CashPro, Bank of America’s digital treasury suite used by more than 40,000 corporate clients worldwide. When the bank combined its Global Transaction Services and Enterprise Payments teams under the banner of Global Payment Solutions in 2023, it created a pipeline for ideas developed in the retail bank to flow into the commercial platform. The most visible import is CashPro Chat, built on the artificial intelligence backbone that powers Erica, Bank of America’s consumer virtual assistant. The tool lets treasurers ask questions and receive 24/7 answers from an “intelligent virtual service advisor,” escalating more complex issues to human specialists, Langford said.

“The more we collectively use it, the more it learns and grows,” she said.

Integration has also sped product rollouts. A U.S. electronic payments collections service that lets businesses accept card and ACH payments will soon debut in Canada after clients “raved about it for years,” she said, illustrating how the new structure “allows us to consider how investments can be leveraged more broadly.”

Listening to the Pros

Listening to clients is as important as engineering. CashPro advisory boards meet regularly “with clients around the world, and that includes right here on the ground in Canada,” ensuring new features target the highest priority wishes, Langford said.

The next inflection point is already on the horizon. The Retail Payment Activities Act will allow nonbank providers to participate directly in the RTR, intensifying competition and giving corporates more ways to customize how they pay and get paid.

“With this complexity, … the goal is to make things easier as they become more complex,” Langford said.

She said she expects that competitive pressure — and the data fabric of ISO 20022 — will trigger a wave of innovation in financing, supply‑chain optimization and value-added analytics.

“The real-time rail will be the platform for future innovation in Canada,” Langford said. “It’s going to increase competition, and when you have increased competition that benefits all Canadians — consumers and commercial entities alike.”

For treasurers, the tools are arriving quickly, and those who master them will turn liquidity management from a back-office chore into a source of strategic advantage.

“We need to be at the table — and we are at the table — to ensure our clients’ voices drive the next three- to five-year journey,” Langford said.

The pay later company and the travel search engine have offered services to travelers in the United States since 2023 and are now bringing their collaboration to Canada, Kayak said in a Thursday (May 22) press release.

“Consumers are increasingly turning to Affirm when booking their flights, hotels, rides and more as flexible payment options remain a top priority for travelers across Canada,” Affirm Chief Revenue Officer Wayne Pommen said in the release. “This expansion with Kayak is a natural next step for our long-standing partnership as we look to offer even more travelers peace of mind when paying for their next trip using Affirm.”

By choosing Affirm at checkout on Kayak’s Canadian website, approved travelers can split the cost of flights, accommodations, and car rentals or car sharing into monthly payments, according to the release.

Affirm already works with several other travel companies, including Booking Holdings brands Agoda, Booking.com and Priceline, which itself owns Kayak.

Kayak Chief Product Officer Matthias Keller discussed with PYMNTS Thursday the company’s launch of Kayak.ai, a conversational travel booking assistant powered by generative artificial intelligence.

“This is not just a chatbot,” Keller said. “It’s a ChatGPT just built for travel. You can ask any travel question, and in a conversation, you get real-life rates that are also bookable on Kayak.”

Kayak.ai was created to emulate natural human conversation and the kind of planning a traveler might do with a knowledgeable agent or friend. It isn’t fully automated, but future versions of the assistant will allow for seamless and even semi-autonomous bookings within the chat itself, Keller said.

“Right now, it’s more like an attended booking within the chat,” he said. “You’ll still see what you’re booking, confirm the price, and maybe enter your credit card. But over time, this could get more and more semi-automated. Maybe you leave your details, and the booking happens in the background.”

Meanwhile, Kayak’s integrations with major airlines, hotel chains and global distribution systems (GDS) offer it a competitive edge, Keller said.