Payers need a proven framework for payment integrity to create financial value, handle change, and engage at the highest levels of organizational strategy. This 5-step methodology works whether the directive is accelerating growth, building from scratch, or somewhere in between.
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Payment Integrity
Improving Payment Integrity with a Building Blocks Methodology
Payers Reduce Administrative Costs by Going Back to Basics with Payment Integrity
In the face of economic and hiring constraints, payment integrity leaders are prioritizing these 4 best practices to shift to an enterprise strategy that offers proven value.
Health Plan Leaders Speak Out on Building the Payment Integrity Organization of Tomorrow
Whether or not health plan leaders implement a fully centralized PIO, sharing information on an enterprise payment integrity technology platform helps overcome challenges and meet strategic opportunity.
Study Reveals Payers Recover Overpayments 50% Faster with Enterprise Technology
In an industry that has struggled to quickly and meaningfully address healthcare claims payment accuracy, digital transformation once again proves its value. How can payers best take advantage of the potential of enterprise technology?
Payment Integrity Leaders Ready For A New Normal
With the ever-changing outlook of the payment integrity industry, now is the time to get ahead by making strategic investments in change.
Are You Hurting Provider NPS with Your Payment Integrity Efforts?
Look out for these 4 elements of payment integrity that may negatively impact provider NPS (net promoter scores) with your network providers. The Net Promoter Score (NPS) – an established metric traditionally managed by insights and marketing departments – can drive...
The Strategic Approach to Claims Cost Containment
Competing with other health plan functions for technology priority can lead to missed audit claims cost savings potential. An integrated payment integrity strategy breaks down these internal silos. With so many moving – and vital – parts within a payer organization,...
ClarisHealth on the Breaking Health Podcast
Listen to this conversation about building the right team and technology to help health plans tackle their entire payment integrity continuum. ClarisHealth CEO Jeff McNeese sat down with Steve Krupa, CEO of Healthedge and contributing host at Healthegy, for the latest...
The Strategy Nearly Every Health Plan Considers: Outsource vs. Insource
Slim margins, fewer resources, and consolidation have made it harder for health plans to compete. Could balancing outsource vs insource efforts accelerate their goals? With shrinking margins, fewer and fewer internal experts, and increasing consolidation, health plans...
6 Steps to a Successful Prepay Strategy
Health plans can take control of their own prospective provider audits instead of over-relying on services vendors with the help of advanced technology and access to proven analytics. We’ve written before about why it’s important for health plans to start thinking...
5 Reasons for Health Plans to Choose a Scalable Payment Integrity Technology Platform
Are you using an assortment of software tools to do work better suited to a platform? You might be missing out. When your health plan starts looking to upgrade your payment integrity and fraud management processes with technology, what do you turn to? A tool or a...
4 Payer Responses to Primary Care Challenges
Primary care providers are the foundation of the healthcare system. With the pandemic putting its future at risk, health plans can take 4 steps to address this challenge. It’s been said that the coronavirus pandemic hasn’t created any new problems; it’s just escalated...
Health Plans Return to Payment Integrity
3 claims trends associated with the healthcare industry getting back to business, and how health plans can smoothly resume payment integrity efforts. Now that the crisis-volume of COVID-19 cases has started to ease across the country, delayed elective procedures and...