Payment Integrity
These services help health plans identify, prevent, and recover unnecessary costs, ensuring claims are accurate, defensible, and aligned with plan interests.
Why Payment Integrity Matters
Healthcare claims systems are complex and difficult to monitor, making it challenging for organizations to detect provider billing errors, fraud, waste, and abuse.
What Healthcare Claims Data Often Reveals
3–12%
Typical claims payment error rates
Hidden Fees
Inflated costs hidden in complex billing structures
Billing Variations
Significant cost differences for similar procedures
Payment Integrity Services by Healthalytica
Our payment integrity services analyze healthcare claims data to identify, prevent, and recover unnecessary payments, providing organizations with deeper control of their healthcare costs.
Prospective Payment Integrity
Analyze and act upon claims in real-time to identify provider billing errors, fraud, waste, and abuse, helping plans prevent costly overpayments before they are made.
Retrospective Payment Integrity
Analyze processed claims data to uncover claims paid in error, discrepancies, and provider billing issues not identified prior to payment, and recover these overpayments through professional and collaborative dialogue with providers to ensure savings are realized.
From Claims Data to Actionable Insights
Analyze
Aggregate and normalize healthcare claims data.
Identify
Detect billing errors, fraud, waste, and abuse across claims.
Optimize
Deliver actionable insights which enable us to prevent or recover overpayments.
Greater Transparency and Insight Into Billing Errors
Financial Visibility
Understand where healthcare dollars are going.
Cost Optimization
Identify inefficiencies and opportunities for savings.
Data-Driven Decisions
Support stronger financial performance.
Analyze large healthcare claims datasets
Identify unusual billing patterns
Detect cost anomalies across providers
Generate clear financial insights
Advanced Claims Analysis
Healthalytica's analytics engine analyzes large healthcare claims datasets to uncover patterns, anomalies, and cost variations that traditional reporting may overlook.
Analyze large healthcare claims datasets
Identify unusual billing patterns
Detect cost anomalies across providers
Generate clear financial insights
Start Gaining Visibility and Greater Control Over Your Healthcare Spending
Discover how Healthalytica's advanced analytics can help your organization prevent or recover claim overpayments due to provider billing errors, fraud, waste, and abuse.
FAQs
Learn more about how Healthalytica helps organizations gain visibility and greater control of their healthcare spending with Payment Integrity Services.
What do Payment Integrity services provide?
These focused services analyze claims data to identify overpayments due to provider billing error, fraud, waste and abuse. They can be used on a post-payment basis, with overpayments recovered by Healthalytica, or on a pre-payment basis to prevent the overpayments from ever being made.
Who are Payment Integrity services useful to?
Any organization responsible for the payment of healthcare benefits such as health plans, self-insured employers, insurance companies, and union benefit funds.
How does Payment Integrity deliver cost savings to my health plan?
We use a continuously-evolving analytics engine based on proprietary algorithms and industry intelligence to identify overpayments.
What makes Healthalytica's Payment Integrity Services different from traditional reporting tools?
We combine a payer-centric approach, with only your best interests in mind. We are not aligned with networks, doctors, or hospitals. Our cutting-edge technology is paired with deep experience to deliver a solution few others can come close to.
How can organizations get started with Healthalytica?
Contact us now to discuss and explore how we can tailor a solution to deliver measurable savings and improve your bottom-line.
