The cost integrity chief’s playbook for achievement in 2022 and past


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Though healthcare funds have undergone main transformations over the previous decade, one factor stays fixed—the necessity for claims cost integrity is paramount for payers. Not solely does each inappropriately paid declare characterize a monetary loss that takes away from member care, however these errors additionally erode the payer-provider-member relationship.

Payers should develop a complete cost integrity technique spanning the complete claims cost continuum. Whereas potential cost integrity options proceed to realize traction, retrospective options will proceed to be a significant a part of any profitable enterprise cost integrity program. Subsequently, a holistic course of that targets the appropriate intervention kind and the appropriate intervention level for every error is important to efficient claims processing, supplier relations, and value financial savings.

Learn our new eBook, The cost integrity chief’s playbook for achievement in 2022 and past, to study the core fundamentals that can make it easier to obtain incremental worth. We provide perception into how one can construct a strong basis for cost success throughout your vital packages, together with:

  • Following finest practices when deploying a prepay declare modifying resolution
  • Strategically utilizing postpay information mining for essentially the most complicated claims
  • Designing a holistic coordination of advantages (COB) course of that considers the complete member expertise
  • Tackling over-coded E&M claims with a focused method
  • Staying forward of the most recent fraud, waste, and abuse traits
  • Managing specialty drug prices going past prior authorizations

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Through the use of the packages, options, and techniques outlined in our eBook, you'll be able to enhance financial savings, enhance supplier relations, and optimize member interactions together with your group.


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