Mid-market health payer achieves $1.8M in savings from pre-pay bill review

Reduces provider abrasion and become more efficient by moving from post-pay IBR



A mid-market U.S. healthcare payer faced ongoing issues with its post-payment itemized bill review (IBR) process that was causing significant provider abrasion. Too much time was spent identifying potential savings and communicating with the provider, explaining over-payments, and attempting to recover on claims already paid. This laborious, time-consuming activity produced marginal results. Further, the post-pay IBR process was greatly straining the payer’s relationship with its network healthcare providers.

Like many U.S. healthcare payers, the company knew it wanted to move to a pre-pay model, which would allow the payer to review payments prior to funds being delivered. However, they were unclear about how to successfully make this transition.

The EXL Health team’s ongoing relationship with the payer assisting with the post-pay IBR program and substantial experience in moving clients from post-pay to pre-pay IBR led to our selection for implementing this healthcare transformation.

Human Ingenuity

Using domain expertise combined with the proprietary technology EXLMINE™, an audit workflow management platform, the EXL Health team dramatically improved both the efficiency and effectiveness of the client’s IBR program.

To transition from post-pay to pre-pay IBR, EXL Health first worked with the client’s team to understand their concerns. They discussed potential barriers to entry and other issues that could unintentionally exacerbate provider abrasion. Because EXL Health has subject matter expertise in many domains, the team was able “speak the language” in multiple areas, giving the payer a clear pathway of what was needed to reach their goal.

The EXL Health team built a program in EXLMINE™ specifically for the payer that supported the client’s data requirements. By transitioning to a digitally-enabled solution, the EXL Health team was able to accurately identify and perform a larger quantity of audits in a faster, more efficient way. This shift also enabled the client to quickly provide accurate data to their providers and maintain compliance within the limited time constraints for a pre-payment review, a critical element for both contractual adherence and preserving provider relationships. Speed and accuracy were both needed and achieved with EXL Health’s pre-pay solution.

EXL Health has the ability to meet healthcare clients wherever they are in making the transition from post- to pre-pay IBR. For this client, EXL Health first helped them with post-pay IBR and then implemented a pre-pay IBR system. In the process of moving the payer completely to pre-pay, EXL Health continued to find and resolve issues that still needed to be addressed in post-pay to ensure a seamless conversion.


The pre-payment IBR program was created and implemented by the EXL Health team in the first three months of 2022 and went live in March. The team has moved the client from all post-pay IBR to all pre-pay IBR. With this change, the client’s review process has become vastly more efficient, and the company achieved substantial savings by determining accurate payments prior to funding.

In addition to making the entire process cleaner and faster, pre-pay IBR eliminated the administrative burden on the backend of post-payment, including tracking all the financial transactions of dollars moving back and forth. The pre-pay program helped reduce provider abrasion and strengthened the relationship between the payer and their providers.

Most significantly, the pre-pay IBR program implemented by EXL Health saved real dollars for the client:

  • Savings from pre-pay IBR far exceeded EXL Health’s projected savings in every quarter during 2022 and is on track to continue at this pace for 2023.
  • In 2021 using post-pay IBR, the client clawed back only $67,000. In the first three months of pre-pay IBR, the client saved $290k.
  • In the first year of the pre-pay IBR program, the client achieved $1.8 million in savings.