Advance your payment integrity program on your terms

Keys to success in working with partners while maintaining control and visibility

As the healthcare industry continues to escalate in complexity, payers are looking at new ways to regain transparency and control for their payment integrity (PI) program. Payer organizations are increasingly building relationships with a few key vendors that can supply domain expertise, technology and analytics to bolster their PI programs – enabling them to benefit from a partner’s specialized expertise and advanced technologies while maintaining valuable control over their data.

Leveraging partnerships to improve payment integrity programs

According to a recent survey by EXL and Healthcare Dive, most payer organizations utilize third-party vendors for various aspects of their payment integrity programs. While stacking multiple vendors with contingency-based pricing models has traditionally been a cornerstone of PI strategies, health plans are increasingly reevaluating their reliance on this approach, as this black-box model can obscure the true cost of recoveries, incentivize volume over accuracy, and lead to fragmented workflows. Greater still, it fails to deliver actionable insights or empower payers to leverage the intellectual property generated during the process.

When it comes to making improvements to within PI programs, payers need to weigh internal capabilities against their specific priorities, challenges, resources, and short- and long-term strategic goals.

More than half of surveyed payers who leverage vendors within PI programs are looking to partner with vendors that have an ability to innovate, according to EXL research.

Unlock deeper insights through transparent and accessible information

EXL provides innovative capabilities to support PI programs of the future, driving enhanced results and long-term success by adapting to the dynamic PI landscape. Using a data-led, digitally enabled approach, EXL delivers domain expertise, advanced technologies, and operational capacity services to help payers identify billing and payment errors with precision and accuracy.

EXL’s modular white-box solution provide tailored support to address a payer’s unique challenges, including analytics services, skilled resources, and audit workflow tools to ensure backlogs are cleared and adjustments remain current. As a result, PI operational efficiency, claims adjudication, and claims adjustments all see improvements.

Download our report and discover how EXL empowers our clients with the right people, processes, and technologies to enhance business outcomes efficiently and effectively.