Transforming payment integrity to prevent aberrant and fraudulent billing behaviors

Health payers must resolve claims accurately and at speed while preventing aberrant and fraudulent billing behaviors – a difficult task at the best of times.

These aren’t the best of times.

However, payers can improve their payment integrity (PI) programs and the claims life cycle end-to-end through data, digital, and analytics. It just takes finding the right strategic partner to enable PI innovation through transformation.

Challenges

Common obstacles payers encounter in their PI programs include:

Attracting and retaining talent

Attracting and retaining talent

Handling new kinds of claims including telehealth, at-home testing, and online counseling

Handling new kinds of claims including telehealth, at-home testing, and online counseling

Moving to value-based payments

Moving to value-based payments

Shifting regulatory landscape

Shifting regulatory landscape

Increasing care services that burden already strained resources

Increasing care services that burden already strained resources

Championing support through executive sponsors and other organizational leadership for funding and alignment

Championing support through executive sponsors and other organizational leadership for funding and alignment

Opportunities for innovation

The right PI practices stop inaccurate payments before they start through comprehensive pre-claims payment and submission and post-claim payment validation capabilities. This can be accomplished through a three-pronged approach:

Opportunities for innovation

 

Take the lead with EXL

EXL can be that experienced partner for healthcare payers transforming their PI programs. Contact EXL for an initial analysis and recommendations on the right tools, solutions and practices needed to institute a best-in-class PI management program today.