Becker's Healthcare August 26, 2024
The continued rising cost of healthcare is prompting many health plans to take a closer look at the value strong payment integrity programs can drive.
Payment integrity (PI) is the process of ensuring a health claim is paid by the responsible party, for eligible members, according to contractual terms and policies, and free of error, duplication, fraud, waste, and abuse. PI addresses both administrative costs and medical expenses – without compromising care. Most plans have PI programs in place, but often they are not optimized and aren’t providing the return on investment (ROI) they could.
Achieving medical claim payment accuracy is difficult for many reasons. Billing is highly complex and requires expertise and conciseness in numerous interrelated areas...
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