Comprehensive Payment Integrity
A centralized approach identifies and generates opportunities to increase medical expense savings.
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.
What makes our Comprehensive PI unique?
We support strategic initiatives in payment accuracy by aligning existing efforts and focusing on moving accuracy to the earliest possible point in the claim lifecycle. We create visibility across the organization of all efforts to optimize results.
Comprehensive PI results
- 2–4% increase in medical expense savings
- $100M+ potential annual claim savings
Leading health plans who have moved to a comprehensive and centralized model are saving 8-10% or more of medical expense annually through their enterprise payment integrity functions.
Chief Operating Officer, Optum Insight
Steve Yurjevich
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