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
Powered by the most advanced payment accuracy engine, we've been driving the industry forward for over 25 years.
Maximize medical cost savings
Our comprehensive suite of pre- and post-payment 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 market-leading education reduce the burden of managing billing errors and medical record requests for providers.
Shift to prevention
We work with providers to build transparency, simplify reimbursement and prevent avoidable denials with real-time error identification.
Payment Integrity solutions
Available both pre- and post-payment, our market-leading suite of solutions improves payment accuracy at every point in the claim lifecycle.
Pre- and post-pay
Coding Advisor
Reduce common billing errors with our proven provider education: 81% of providers demonstrate positive behavioral change.
Pre-pay
Claim Pricing solutions
Improve the accuracy and efficiency of your prospective payment system pricing.
Pre-pay
Claims Edit System
Achieve clean claims and maximize medical spend savings with our flexible, real-time claim editing software.
Pre- and post-pay
Claim Review
Prevent improper payments, reduce medical spend and minimize provider abrasion with our comprehensive suite of pre- and post-pay soutions.
Pre- and post-pay
Coordination of Benefits
Identify and validate primary policy coverage with accurate eligibility data.
Post-pay
Credit Balance Resolution Services
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.