Adding a robust, centralized claims review system can help save time and money and strengthen payer, provider and member relationships
To maximize savings, lower administrative and medical costs, and improve relationships with providers, health plans must have an effective payment integrity plan. A comprehensive approach — one that ensures a health plan pays the correct provider the correct amount at the correct time — centers around a robust claims review program.
Today, this multifaceted process is more important than ever, as improper payments due to incorrect coding, medical waste, fraud and processing errors pose increasing financial risk. In fact, payment accuracy problems are growing at about the same rate as medical inflation — a hearty 5% to 8% of all claims are paid inaccurately. And an estimated $100 billion may be lost to medical fraud, waste and abuse each year.1
An all-in, centralized claims review can contain costs while boosting the consumer and provider experiences.