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2025 BEST IN KLAS
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Related Series
2023
Related Segments
Payment Accuracy & Integrity 2025
Shifting Focus from Payment Recovery to Error Prevention
Author
Mark Allphin
Author
Jennifer Hickenlooper
Author
Aurene Wilford
Rising healthcare costs—driven by increased utilization, expensive therapies, and inflation—have heightened payer organizations’ focus on payment integrity as a key strategy for ensuring appropriate payment. Multiple payers are looking at shifting their strategies from traditional recovery models to pre-payment review models to identify errors before payments are finalized and to ensure medical loss ratio protection. Amid this shift, some payers are also considering consolidating vendors or insourcing payment integrity operations to gain greater control over their processes and reduce abrasion enterprise-wide. This report looks at which vendors offer pre- and/or post-payment solutions and how well clients feel their vendors partner to not only deliver traditional audit and recovery functionality but also strategically prevent payment errors and streamline workflows.
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Key Findings:
- Cotiviti & Optum Have Broadest Portfolios, Though Customers Say Value Is Diminished by Gaps in Support & Service Quality
- HealthEdge, Lyric & Zelis Facilitate Accurate Payments & Drive Value
- Across Vendors, Customers Desire Solution Capability Improvements
- TREND Health Partners & Machinify Praised for Strategic Partnership & Consistent Results
- Inconsistent Follow-Through a Challenge for Conduent, Cotiviti, EXL & Optum
- Across Vendors, Post-Payment Clients Call for Better Reporting & Real-Time Analytics
Writer
Sarah Brown
Designer
Nikki Christensen
Project Manager
Sydney Toomer
This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2025 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.