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2026 Payment Integrity Benchmarking Report

A Better Set of Problems: How Concept Breadth Shapes Payment Integrity Performance

New data from 18 health plans reveals why the programs recovering the most aren’t just working harder — they’re measuring differently.

In this report, you’ll find:

    • Why concept coverage grew from 655 to 1,014 concepts across the peer group — and why savings per concept nearly doubled ($8.4M → $14.4M) in the same window
    • A 14-category savings breakdown showing where the money actually is
    • The Total Savings vs. Average Savings per Audit quadrant model, so you can spot “Hidden Yield” categories worth prioritizing even at lower volume
    • A peer coverage matrix showing where even mature programs have unmapped gaps
    • The top 10 highest-performing concepts in the industry, ranked by 2025 recoveries

ClarisHealth’s second annual benchmarking study analyzed 21 million audits and $17.8B in claims savings across 18 health plans on the Pareo® platform. The finding: concept breadth has a measurable, compounding relationship with savings yield. Plans that expanded their concept coverage between 2023 and 2025 didn’t just recover more — they recovered more per concept, year over year.

"The scariest thing in payment integrity isn't what you know you're missing — it's what you don't know you don't know."

Tom Baggett, Senior Director of Operations and Client Success, ClarisHealth