Why Now is the Right Time for Implementation

Jun 12, 2018

Total payment integrity implementation can help you right now – even if your health plan is in the middle of a claims system project.

You know that old saying, “The best time to plant a tree is 20 years ago. The second-best time is now.”? It’s a similar situation with health plans and payment integrity solutions: too easy to put off in favor of “more important” things to do. In particular, health plans are always tinkering with their claims systems – adding on to the existing system or implementing a new one. With this, resources can feel constricted to the point that they think they “can’t possibly take on another project.” Even one that could add a lot to their bottom line – a comprehensive payment integrity solution like Pareo.

In the balancing of competing priorities, health plans shouldn’t have to choose their claim system OR a payment integrity solution. For health plans in the midst of a new claims editing solution, here’s why now is exactly the right time to take on a project like Pareo.

Why Claims Payment Integrity Is Just A Piece – Not the Whole Puzzle

Without a doubt, claims systems are vital to claims integrity and health plan payment integrity programs. But too often, we speak with health plans and payers whose sole focus is on claims payment integrity. That is to say, that instead of focusing on the comprehensive aspects of total payment integrity, a health plan may only look at claims editing and therefore are missing out on greater benefits (often unearthed in a payment integrity audit). In truth, a robust payment integrity program offers features that extend beyond claims editing, which all equate to an increased ROI for health plans and payers.

Defined, payment integrity seeks to automate the payment of health insurance claims in a transparent manner to ensure you avoid improper payments. Comprehensive, or complete, payment integrity will also ensure quick payment to providers, employ predictive analytics, and streamline operations so that a health plan can grow recoveries.

The Case for Comprehensive Payment Integrity Implementation – Now

You may delay consideration of a comprehensive payment integrity program because of ongoing claims solution implementation. You don’t have to. While you’re making changes to a claims editing system is actually the optimal time to consider the addition of Pareo. Here are some implementation considerations for health plans in the midst of claims payment integrity:

Define new system processes all at once.

Implementation of technology in healthcare is not new to our industry. Waves of healthcare innovation have swept through over the last several decades, and while many can agree these changes have been for the greater good, they have not been without their pain points. Implementing new processes is a particular challenge for our industry, as we face valued employees who are weary with perceived “change after change.” Co-implementation of a claims editing solution and comprehensive payment integrity allows a health plan to combat this challenge and define new system processes all at once, making launch much easier to roll out.

Mitigate the risks of avoiding payment integrity.

By tying up all your resources in claims editing, other areas of comprehensive payment integrity go unnoticed. Payment integrity audits regularly unearth oversights in payment error and recovery, leading to leakage and improper payment liability. Additionally, health plans that segment their payment recovery efforts miss out on greater process improvements like system-wide automated workflows, real-time data, and vendor management. With these benefits in mind, we advocate that health plans and payers can’t implement total payment integrity soon enough, even if other healthcare information systems are being rolled out.

Rely on vendor assistance for implementation.

As you consider expanding your claims payment integrity system to include more comprehensive functionality, take note of payment integrity vendors who assist with multiple system integration during implementation. ClarisHealth works closely with clients to ensure that Pareo, our total payment integrity solution, is implemented seamlessly with other systems. As a comprehensive tool, we understand how vital it is for a health plan to see a continuous process improvement across their system. Therefore, we ensure Pareo is implemented and integrated with the other vendors and technology tools your health plan has in place.

Growth is Never Stagnant

For health plans and payers that seek to improve recoveries, the time to implement a payment integrity solution is now. Co-implementation of health information systems is not – and should not be – a mutually exclusive process. Don’t get caught in a claims-only mindset. Grow your health plan’s recoveries, reduce administrative costs, and streamline vendors by investing in a total payment integrity solution.


Now’s the time for total payment integrity

See the ClarisHealth 360-degree solution for total payment integrity in action.

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