According to recent research by EXL and Healthcare Dive, healthcare payers are serious about their intent to adopt new technologies within their payment integrity (PI) programs. Companies are considering advanced AI, including Agentic AI and Gen AI, alongside machine learning (ML), and natural language processing (NLP) to help identify patterns, detect fraud, and predict potential payment issues, leading to more accurate and compliant claims processing.

Payer organizations are quickly turning to AI technology

EXL’s research showed that most payer organizations currently are using digital tools to improve auditor efficiency, the selection process, and provider management. Fewer companies are using digital tools to manage multiple vendors and to report or find payment exposure due to contractual agreements.

When asked about the future, most payers are planning to implement new digital solutions to further improve their payment integrity processes, including data visualization tools, claims analysis software, and predictive modeling tools.

Nine out of 10 payer executives are considering integrating generative AI in their PI programs for faster, more accurate audit processes within the next one to two years.

Empower your payment integrity programs with scalable, digital transformation

EXL unlocks the power of data, advanced AI, and deep domain expertise to efficiently recapture overpayments while also mitigating their root causes, especially for complex clinical claims that require deep knowledge and are traditionally handled through slow, manual processes.

Our solution leverages a multi-technology ecosystem—integrating cloud-based big data infrastructure, AI-driven automation, generative models and advanced analytics—delivering real-time integration of diverse data sources and probabilistic rules to enable automated decisions. An intelligent analytics layer, reinforced by auditor feedback, captures issues upstream while targeted human intervention ensures accuracy.

Processing over $3 billion in claims volume in significantly reduced timeframes, our AI engine seamlessly combines predictive modelling, natural language understanding and advanced data processing to identify and audit erroneous claims. This leads to greater recovery rates, improved specificity, and fewer false positives, enhancing both financial outcomes and provider relationships.

View our infographic to learn more on how to unlock the power of AI to find more savings with speed and accuracy, extract valuable insights, enhance your complex audit operations, and reduce abrasion in the healthcare payment cycle.