Although healthcare payments have undergone major transformations over the past decade, one thing remains constant—the need for claims payment integrity is paramount for payers. Not only does every inappropriately paid claim represent a financial loss that takes away from member care, but these errors also erode the payer-provider-member relationship.
Payers must develop a comprehensive payment integrity strategy spanning the entire claims payment continuum. While prospective payment integrity solutions continue to gain traction, retrospective solutions will continue to be a vital part of any successful enterprise payment integrity program. Therefore, a holistic process that targets the right intervention type and the right intervention point for each error is essential to effective claims processing, provider relations, and cost savings.
Read our new eBook, The payment integrity leader’s playbook for success in 2022 and beyond, to learn the core fundamentals that will help you achieve incremental value. We offer insight into how you can build a solid foundation for payment success across your critical programs, including:
- Following best practices when deploying a prepay claim editing solution
- Strategically using postpay data mining for the most complex claims
- Designing a holistic coordination of benefits (COB) process that considers the entire member experience
- Tackling over-coded E&M claims with a targeted approach
- Staying ahead of the latest fraud, waste, and abuse trends
- Managing specialty drug costs going beyond prior authorizations
By using the programs, solutions, and strategies outlined in our eBook, you can increase savings, improve provider relations, and optimize member interactions with your organization.