Pre-pay reviews require speed and accuracy for success

The healthcare industry has been evolving to identify errors and inaccuracies prior to payments rather than after the fact. This proactive approach to auditing provides many benefits but is not easy for payers to achieve due to factors such as operational limitations, data complexities, contract requirements, and regulatory compliance.

A recent EXL and Healthcare Dive survey asked healthcare payers for insights on their PI program, including their current state of pre-pay auditing rates as compared against payer goals and the top obstacles to pre-payment success. While 76% of payer executives would like to audit a higher percentage of claims before payment, respondents cited multiple barriers to reaching this goal, including the need for rapid adjudication and better selection accuracy rates.

Achieving pre-payment success doesn’t have to be an uphill battle.

Turn to AI technology to find the root causes of errors

At EXL, our cutting-edge PI ecosystem integrates advanced digital solutions, established AI technologies, and new large language models to help our clients scale seamlessly and maximize recoveries at minimal administrative cost. This AI-enabled approach not only provides the necessary speed and accuracy, but also helps payers shift upstream to identify and address the root causes of errors earlier in the claims lifecycle. By quickly finding these underlying issues, payers can help change provider practices and prevent overpayments from happening in the first place, shifting the focus from managing symptoms to addressing the issue at the source.

Download our report and discover how AI is revolutionizing healthcare operations with root cause analysis, speed, and accuracy.