“Our preference has always been to get as much prepayment as we could, because it tends to be more efficient and create less hassle and frustration for the physicians who are usually the ones that bear the brunt of the editing.” That’s how the chief executive officer of one health plan responded when we recently conducted a survey of more than 100 health plan leaders in partnership with HealthPayerIntelligence to examine how payers are balancing prospective and retrospective payment integrity across their enterprise.
But postpayment integrity is hardly going away, of course. For example, while eligibility checks are conducted before claims are paid, other aspects of coordination of benefits, such as those that are linked to the member lifecycle, must generally be conducted retrospectively. The challenge for health plans, then is how to optimize the efficiency of their postpay programs and move concepts from postpay to prepay when feasible—all while making sure their prospective and retrospective operations are in complete alignment with each other.
I hope you can join me and my colleague Brett Arnold, vice president of product management, as we review this in a brief half-hour webinar, available on demand.
We’ll break down the results of our recent survey and provide best practices on how to:
- Manage an enterprise payment system across multiple stakeholders
- Attack inappropriate payments depending on the claim type, area of concern, and typical claim lifecycle
- Find the best intervention points in the payment integrity continuum to maximize value
Only by implementing a true enterprise strategy and removing silos between internal teams and vendors can payers maximize the ROI of their payment integrity programs. Watch our webinar and learn how.