Diagnosing Your Payment Integrity Program’s Ability to Scale: Gaps and Next Steps
Whether you are building, re-defining or optimizing your payment integrity strategy in alignment with your health plan’s goals, here’s what you need to know so you can make your next moves with confidence.
Many PI leaders are being tasked with dramatically increasing claim savings. You may have taken steps to increase visibility and control over your programs but still struggle with scaling processes or taking the right action needed to address hot button and recurring issues.
At ClarisHealth, we’ve assessed, consulted on, and partnered with dozens of payment integrity programs over the years. Based on that experience, we have developed and refined a four-stage model with distinct markers of payment integrity program scalability organized around seven dimensions. But you don’t have to go that deep just yet. We find that just 10 focused questions can help leaders diagnose their programs and think more strategically about how to get to where they want to be.
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