Payment integrity

Payment integrity

Let’s transform your business with industry-recognized best-in-class payment integrity services that ensure excellence in payment accuracy

Payment integrity

Let’s transform your business with industry-recognized best-in-class payment integrity services that ensure excellence in payment accuracy

Let’s partner your way to address your unique payment integrity challenges

At EXL Health, we believe in a modular approach to payment integrity, allowing our customers to access vendor software, analytics, people, and processes to transparently identify and address overpayments, trends, and unique business challenges. Our innovative approach provides payers deeper insights into their payment integrity program through transparent and accessible information. Whether looking for a traditional solution or components within a modular delivery model, we partner with our clients to help make healthcare transformation happen.

Who we serve

EXL Health partners with and delivers our payment integrity services to both health plan payer and provider organizations. We support driving value-based outcomes and transformation in order to ensure payment accuracy and reduce fraud, waste, and abuse.

EXL Health is a proud to partner to:

  • 7 of top 10 US Payers
  • 2 of the top 3 PBMs

Proven outcomes: human ingenuity at work

One of our long-standing payer clients was looking to streamline their payment integrity program, specifically their Diagnosis-Related Group (DRG) auditing solutions. As their most trusted and first-pass post-pay vendor for DRG coding and clinical auditing services, they approached EXL when looking to reduce vendors to decrease administrative and operational workloads within vendor management. Leveraging human ingenuity, technology, and analytics-enabled solutions, EXL’s payment integrity solution was able to impact payment accuracies, cost management, and quality outcomes – all key to value-based performance success.

By partnering with our client to better understand their needs and implement custom solutions, EXL Health was able to create significant value to the organization, yielding an improved savings rate of 120% within 2020 and 2021.

  • 30% overall DRG savings for client in 2020
  • 56% overall DRG savings for client in 2021
  • Expected continued growth in 2022
  • Improved resource efficiency due to streamlining from a singular vendor
Featured insights
A large pharmacy benefit management organization came to EXL Health several years ago to provide a solution to a major issue they were experiencing. EXL Health solved the issue within three months, subsequently going on to generate massive incremental performance improvements for this client with total net recoveries increasing from $35M in 2021 to $52M in 2022.
A leading US-based health plan needed support for their payment integrity professional program, a process that identifies and addresses the overbilling and overpayment of claims generated for work performed by physicians. Professional claims cover certain procedures including labs and tests in various primary care, surgical, and specialty areas.