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.
Service
Coding Advisor
Help providers reduce common billing errors with a proven education solution.
Software
Claim Pricing solutions
Improve the accuracy and efficiency of your prospective payment system pricing.
Software
Claims Edit System
Achieve clean claims and maximize medical spend savings with our flexible, real-time claim editing software.
Service
Claim Review
Prevent improper payments, reduce medical spend and minimize provider abrasion with our comprehensive suite of pre- and post-pay solutions.
Service
Coordination of Benefits
Identify and validate primary policy coverage with accurate eligibility data.
Service
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.
Industry insights
Article
Explore real use cases for using AI to drive payment accuracy and the effective ways health plans are leveraging these emerging technologies.
E-book
Discover the 5 key components of a high-performing payment integrity program. Build a structure that helps optimize savings.
Article
Discover how health plans can reduce billing errors and strengthen provider relationships through AI-enabled proactive education.
E-book
Learn how to create a framework that drives payment accuracy on the first pass.