Trends shaping the future of payment integrity
Payment integrity is facing challenges fueled by rising medical spend, regulatory shifts and higher stakeholder expectations. Explore the market trends that are shaping the future of payment integrity and what they will mean for health plans.
Key benefits
As medical costs continue to rise, health plans are challenged to deliver cost savings without amplifying member and provider abrasion.
Maximize medical cost savings
Our suite of Payment Integrity solutions can help you achieve 8-10% medical cost savings annually.
Industry-leading expertise
Our content and analytics suites use AI and human expertise to enable more precise claim selection and proactively identify emerging trends.
Improve the provider experience
Our digital-first tools and educational resources reduce the burden of managing billing errors and medical record requests for providers.
Shift to prevention
We’re working directly with providers to build transparency, simplify reimbursement and prevent avoidable denials.
Payment Integrity solutions
Available both pre- and post-payment, our suite of solutions improves payment accuracy at every point in the claim lifecycle.
Coding Advisor
Help providers reduce common billing errors with a proven education solution.
Claim Pricing solutions
Improve the accuracy and efficiency of your prospective payment system pricing.
Claims Edit System
Achieve clean claims and maximize medical spend savings with our flexible, real-time claim editing software.
Claim Review
Prevent improper payments, reduce medical spend and minimize provider abrasion with our comprehensive suite of pre- and post-pay solutions.
Coordination of Benefits
Identify and validate primary policy coverage with accurate eligibility data.
Credit Balance Resolution Services
We help health plans identify, research and resolve overpaid claims.
Optimize your payment integrity program
Optimize your payment integrity program with our Comprehensive Payment Integrity Assessment. Our team of experts will analyze your current program to identify gaps and opportunities for improvement, providing you with a strategic roadmap to modernize your payment integrity office and increase medical spend savings.
Related healthcare insights
E-book
Learn how to create a framework that drives payment accuracy on the first pass.
White paper
Discover payment integrity best practices to help you achieve your in-year cost savings goals.
White paper
Find out what is driving abrasion and what health plans can do to alleviate pain points.
White paper
Unpack key trends shaping the future of payment integrity and discover steps you can take to get started on your path to payment precision.