Payment Integrity

Challenges and pressure to reduce healthcare costs, increase recovery rates and avoid overpayments continue to rise. Health plans strive to improve payment integrity capabilities by transforming outdated technology and processes. But most point solutions lack transparency or only provide a one-sided view across business lines, which leads to increased administrative and medical costs. They also rely on retrospective pay-and-chase models with minimal intention to fix the root cause. It’s time to shift from the pay-and-chase model of payment integrity to a model that will enable near real-time accurate payments.

We can help. As a trusted global innovator, we assist health plans in harnessing next-generation intelligence and advanced analytics through our Medical Cost Manager (MCM). We combine advanced data management with Fast Healthcare Interoperability Resources (FHIR) integration for real-time data collection to bring a unified, holistic view of high data value points from claims and membership information. This approach provides a complete view with more transparency and insights to detect and prevent overpayments to improve cost avoidance. See what MCM can do for you.