Building a successful payment integrity (PI) program has become increasingly challenging in today’s complex landscape. As medical billing and payment processes grow more intricate, payers face greater difficulties in identifying and recovering payment discrepancies caused by errors and billing inconsistencies.

These variances cost the healthcare industry billions each year, and they keep increasing as changes in care delivery, billing and reimbursement models add new potential error sources. With advances in cloud technologies, the rise of generative AI (genAI) and improvements in selection algorithms, growing numbers of payers are seeking to shift these checks and audits upstream to identify anomalies earlier and catch more errors before payment. As these payers transition from reactive to proactive approaches to PI, they’re exploring innovative programs like provider education and leveraging new analytic tools to identify the root causes of overpayments faster, eliminating problematic issues and trends earlier in the value chain.

Download our latest report to discover the five key things that winning payment integrity programs do differently and how these strategies help deliver real-world benefits.