Faced with shifting regulations, growing administrative complexity, high-dollar claims, and the looming potential of audits, payment integrity is an increasingly important priority for payers. Payers realize that when they make the correct payments to providers initially, they increase trust, reduce provider abrasion, and lower appeal rates.
Traditionally, many health plans have outsourced payment integrity work to vendors who perform reviews, and then return the results to those health plans. However, much of the outsourcing industry works on contingency fee schedules and is primarily paid for finding errors.
