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

Performance

Payment Accuracy & Integrity Solutions 2023

24 October 23 | Joe VanDeGraaff and Ruirui Sun

Payers take on financial risk for members and pay for healthcare expenditures based on various plans and reimbursement types. Due to the complexity of reimbursement contracts, many factors (e.g., coding and billing errors, fraud, waste) can contribute to payers sometimes underpaying or overpaying provider organizations. Payment accuracy and integrity solutions help payers make accurate payments and recover losses when overpayments and fraud occur. This report—KLAS’ first on this market—aims to identify the main capabilities these solutions provide and show early findings on customer satisfaction with vendors’ performance. Note: Research in this report is based on feedback from interviewed payer customers. This report is not intended to compare measured vendors’ technological capabilities.

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+

Payment Accuracy & Integrity Solutions (Payer)

Past Payment Accuracy & Integrity Solutions (Payer) Awards

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