An out-of-the-box approach to an efficient payment integrity program should have capabilities across five key areas:

CONTENT

Accurate coding and payments depend on consistent updates as new regulations are enacted and policies are released. Therefore, staying up to date is essential.

CUSTOMIZATION

No two payers are the same. Customization allows health plans and TPAs to tailor their payment integrity operations to their unique business needs and policies.

COMMUNICATION

Better communication between payers and providers is crucial to improving relationships between them, but it is often wanting.

CONSULTING

Having worked in siloed environments historically, few payers have insights into how the wider industry operates, which can put their organizations at a disadvantage.

COLLABORATION

For payers to respond effectively, they need a partner to help them navigate uncertainty while optimizing existing payment integrity operations to weather future storms.