In recent years, health plans have made significant progress in moving their payment integrity strategies from postpayment correction and recovery to catching inappropriate claims before payment occurs. But as healthcare costs continue to rise and the demands for cost savings increase, payment integrity programs have become increasingly layered, nuanced, and complex.
No longer is the payment timeline simply thought of as “before payment” or “after payment”—instead, it’s more of a connected claim continuum, where each claim must be processed at the right intervention point to deliver the highest value and the lowest abrasion.
