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Payment Accuracy & Integrity Solutions (Payer)
 

Vendor software solutions used by payers to help ensure accurate payment/reimbursement. Common capabilities in payment integrity include both pre-pay functions (i.e. processes to ensure accuracy before payment is made) and post-pay functions (i.e. processes that identify or recover losses after payment is made.).

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Boyd Stewart
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KLAS Research Director - Boyd Stewart
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Performance Data

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Related Articles
Article
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Payment Accuracy & Integrity Solutions: Mapping out a Complex Market
28 November 23    |   Joe VanDeGraaff and Ruirui Sun
In October, KLAS published the 2023 Payment Accuracy and Integrity Solutions report—our first on this highly complex and important segment.
Current Time Inside Cache Tag Helper: 4/23/2024 3:33:25 AM and Model.SegmentId = 330
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Performance
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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.
First Look
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Cotiviti Payment Accuracy Solutions
11 October 23    |   Jacob Brown and Joe VanDeGraaff
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.
Emerging Technology
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HealthEdge Source 2023
03 February 23    |   Dallin Seely and Joe VanDeGraaff
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.



Reducing Filters

Unlike sizing filters, reducing filters DO NOT recalculate scores based on the evaluations that meet these requirements. They narrow the list of solutions to show the vendors and solutions that can meet a specific need.

This data is based on interviews with a sample of the firms' recent clients. As a result, it is not necessarily comprehensive of all work a firm may do in this segment.

We require a minimum of 2 confirmations of a service performed in the last 3 years for a solution to qualify.

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