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"Building a Highly Effective Payment Integrity Program"

This playbook explores the 5 key attributes that set winning payment integrity programs apart.

Effective payment integrity programs are crucial as medical billing complexity costs healthcare billions annually. Once almost entirely limited to analyzing payments already processed, new technological developments have shifted payment integrity programs to operate earlier and earlier in the payment cycle. Cloud technologies, generative artificial intelligence, and selection algorithm improvements all support the identification of anomalies before payment.

This playbook highlights five key attributes of successful programs, helping payers maximize recoveries and minimize costs, with some achieving millions in annual savings. We’ll explore:

• Using advanced analytics and predictive modeling for healthcare data insights
• Transitioning from "pay and chase" to real-time error detection
• Implementing AI-enabled solutions to address staffing challenges

Offered Free by: Healthcare Dive's studioID and EXL
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