4 Transformative Ways Technology is Reshaping Payment Integrity (PI)

Imagine a world where the friction of provider abrasion fades into memory, a world where hours spent wrestling with multiple PI vendor contracts are replaced with a click of a button, and where auditors are empowered to create and manage their edits without the shadow of the IT waiting game. This is not some far-off dream—it’s the world that next-gen payment integrity technology is carving out today. The landscape of health plans is evolving, and in this dynamic scenario, technology has emerged as a beacon of efficiency, accuracy and insight. Here are the four most critical transformations that technology is driving:

1. Reducing Provider Abrasion

One of the significant challenges health plans face today is the frustration and friction caused by overlapping audits, often leading to provider abrasion. With multiple payment integrity companies targeting the same claim, the resulting disruption can strain relationships with providers. The advent of Software as a Service (SaaS) platforms is proving to be a game-changer in this aspect. By consolidating findings from various audit vendors into a single database, these platforms can significantly reduce the potential for confusion and provider abrasion. A unified view of audit outcomes clarifies which vendor identified which discrepancy, thereby minimizing disruption and ensuring smoother provider interactions.

2. Saving Time, Money, and Resources

Modern PI technology focuses on efficiency and cost-effectiveness. It streamlines processes, eliminates the need for multiple vendor contracts and reduces the administrative burden on health plans. Advanced platforms can consolidate information from disparate systems into one, allowing for real-time automated reporting of key metrics. This consolidation not only saves significant time and resources but also enables health plans to identify more recoveries, remove inefficiencies and lower the cost of member care. The result is a more effective, less burdensome claims auditing process that enhances overall productivity.

3. Building Your Own Edits

A new era of user empowerment is here. Health plans no longer need to depend on external IT teams or extensive technical know-how to create and manage their edits. Next-gen audit management systems provide an intuitive Edit Engine, allowing non-technical users to develop, edit and test edits effortlessly. These systems eliminate the IT waiting game and provide auditors with a seamless self-service platform. By giving health plans the tools to build their own edits—and own the rights to them—these platforms offer an unmatched level of control and transparency.

4. Understanding the Root Causes of Overpayments

Lastly, understanding the root causes of overpayments is critical for prevention and future discrepancy mitigation. Advanced PI platforms provide the necessary tools and insights to not only identify overpayments but also understand why they occurred. This knowledge empowers health plans to correct systemic issues, implement changes, and reduce the likelihood of recurring claim errors. This level of understanding is crucial in the pursuit of true payment integrity, enabling health plans to make data-driven improvements for long-term efficiency and accuracy.

Editor’s Note: ClearBridge from Penstock is an example of a SaaS platform that embodies these technological advancements. It offers a comprehensive solution for health plans seeking to handle payment integrity in-house. It not only provides a user-friendly platform but also gives auditors the necessary tools to understand the root causes of overpayments, correct them and implement edits. It is a testament to the power of technology in transforming the payment integrity landscape.

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