From Pay-and-Chase to Proactive: How AI Is Transforming Payment Integrity
Annual U.S. healthcare spending has surpassed $4.9 trillion, with nearly 15% lost to fraud, waste, and abuse. For payers operating on razor-thin margins, this is a critical challenge. But there’s a solution: AI-powered payment integrity programs.
In this exclusive report, From Pay-and-Chase to Proactive: How AI Is Transforming Payment Integrity, we explore how AI is reshaping the payment integrity landscape, enabling payers to move from reactive “pay-and-chase” models to proactive prevention of improper payments. Learn how leading health plans are leveraging AI to reduce costs, improve efficiency, and strengthen provider relationships.
What you’ll discover:
Actionable insights from industry leaders and real-world implementations
- The four AI technologies transforming PI: Machine Learning, NLP, Generative AI, and Agentic AI—how each works and where to apply them across the claims lifecycle
- Real results from early adopters: See how AI is driving measurable improvements, including a 50% increase in savings from selected claims and doubling auditor productivity.
- Implementation roadmap: How to scale AI at a pace your organization can handle, including actionable advice on building AI-powered payment integrity programs, from data preparation to modular adoption strategies.
- The future of payment integrity: How real-time claims processing will transform the industry—and what it means for your organization
- Provider-centric strategies: How to reduce total costs by helping providers make fewer errors and strengthening relationships
- Expert insights from EXL leaders: Perspectives from healthcare solutions executives on the seismic shift happening in the industry
Why this matters now
The healthcare industry is at a tipping point. With AI adoption accelerating, payers that fail to modernize risk falling behind. This report provides the insights you need to stay ahead of the curve, reduce costs, and improve operational efficiency.
"I think our industry is about to undergo a seismic shift. When you go into a pharmacy, you don't wait six months to receive a benefits determination. If data is appropriately distributed and integrated, AI will enable the same kind of convergence, where payers receive claims immediately upon submission and process them right away."
Arun Rangamani
Senior Vice President, EXL
Download the report
Ready to transform your payment integrity program? Download From Pay-and-Chase to Proactive: How AI Is Transforming Payment Integrity today and discover how AI can help you achieve immediate savings, streamline operations, and build stronger provider relationships.