2024 Best In KLAS Payment Accuracy & Integrity Solutions (Payer)

Point of Light

Points of Light 2025 Case Study 8

13 May 25 | Aurene Wilford and Boyd Stewart

The payer organizations in this collaboration were struggling to access patient data in a timely manner to determine risk scores and meet quality measures. Historically, the organizations would send requests for medical records to Healthcare Organization 8 at a certain time of year, which overwhelmed that organization. To mitigate these challenges, the stakeholders collaborated with Moxe Health and Cotiviti to automate the release of information (ROI). This led to a more efficient ROI process and time savings for the payer and healthcare organizations.

Patient data sharing has quickly grown much more important for payer organizations, and recent CMS mandates have made it a necessity for all. Recognizing the burden on payers, Onyx has created a platform that transforms healthcare data into a shareable, compliant format requested by the payer. This report presents a first look at the experiences of Onyx payer customers.

As healthcare claim volumes grow, payer organizations are working hard to ensure problematic claims do not sneak through the claims process. Cotiviti’s payment accuracy solutions are intended to shoulder the review burden across all major claim types and review stages and to reduce unnecessary spend via improved accuracy. This report offers a first look at customers’ experience with Cotiviti’s payment accuracy suite.

Keeping up with Medicare pricing, making edits, and processing claims can be burdensome for healthcare payers. HealthEdge’s Source product (acquired from Burgess in 2020) is intended to ease these burdens by automating important steps in the claims process, providing biweekly updates around Medicare pricing guidelines, and offering first-pass pricing and editing. This report examines HealthEdge customers’ satisfaction and the outcomes they have achieved with the solution.

	Overall performance score (100-point scale)	Trend (2023-2024)	# of unique orgs	Culture	Loyalty	Operations	Product	Relationship	Value

Zelis Healthcare Payment Integrity Solutions (Mostly Pre-Pay)	92.2	N/A	17	A-	A+	A-	A	A	A

Lyric ClaimsXten (Pre-Pay)	90.0	N/A	17	A-	A+	B	B+	A-	A-

Conduent Payment Integrity Solutions (Post-Pay)	88.4	N/A	10	B	B+	B+	B+	A	A

EXL Payment Integrity Solutions (Mostly Post-Pay)	87.0	N/A	7	A	B	B+	B	A-	A

Cotiviti Payment Accuracy Solutions (Pre-Pay and Post-Pay)	83.7	N/A	17	B-	A-	B	B-	B	B+

Optum Payment Integrity Solutions (Pre-Pay and Post-Pay)	78.5	N/A	13	C-	B	B-	C+	C+	B-
	50.0	100.0

	Overall Performance Score (100-point scale)	# of unique orgs	Culture	Loyalty	Operations	Product	Relationship	Value

Claritev (MultiPlan) MultiPlan Payment Integrity Solutions (Pre-Pay and Post-Pay) L	91.4	4	A	A	A	A-	A	A-

HealthEdge Source (Pre-Pay)	86.3	9	B-	A	B	B+	A-	B+

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