Payment integrity is a critical process for payer claims management. Payment reviews ensure payers are reimbursing providers accurately and appropriately for high-quality care rendered to members.
However, most payer payment integrity strategies are leaving money on the table and potentially impacting the member experience if the care associated with payment is not up to clinical or payer standards.
This eBook covers:
“The issue with post-payment review is the way you recover. It is an offset. That offset can be a pretty big dollar amount and years after the service was delivered. It can end up being really burdensome for the provider.”
– Amy Anzola, Vice President, Hospital Bill Review at Zelis
“If you’re able to catch payments before they go out the door, it is more efficient on the payment and the revenue side. It is also less of an administrative burden on both the payer and the provider side.”
– Bonnie Coburn, Vice President, Product Claims Editing at Zelis