Payment integrity as a strategic asset

We review health plans’ existing payment integrity solutions and organizational structure and create a PI assessment. Our assessment goes beyond reducing claims payment to analyze:

• Operational efficiencies
• Medical expense savings
• Provider relations

After our assessment, plans can further engage us to assist in setting up a centralized payment integrity office to manage internal and vendors' solutions. We align teams on reducing pre-payment costs and developing ongoing ideation for new savings opportunities and increased provider and member satisfaction.

When setting up centralized oversight, we focus on detection and prevention as well as discovery and investigation. We provide unified dashboards to ensure the plan is firmly in control.