Infographic: A Fresh Approach to Improving Payment Integrity

Top Payment Integrity Goals for 2025: What Payers Are Focusing On

A survey of over 100 healthcare plan leaders highlights the current state of payment integrity and payers' goals for the next two years. The research identifies the top payment integrity goals through 2025.

• In-sourcing more payment integrity functionality (59%)
• Deriving valuable analytics for better business decisions (53%)
• Increasing IT ecosystem interoperability (53%)
• Reducing operating costs (50%)
• Shifting payment integrity capabilities upstream to pre-adjudication/pre-pay (50%)
• Reducing dependence on contingency vendors (35%)

Overcoming Barriers in Payment Integrity

The survey revealed a significant barrier: while all departments are involved in payment integrity efforts, they are not aligned, resulting in frustration over the lack of progress. A key insight is that 74% of health plans find it highly valuable to access all pricing and policy edits from a single platform. This approach promises several benefits:

• Fewer dependencies on third-party vendors
• Greater visibility into root causes of inaccurate payments
• Enhanced ability to identify and resolve issues pre-adjudication
• More insightful analytics from consolidated data
• Increased productivity of internal payment integrity teams
• Fostering innovation-oriented vendor relationships

HealthEdge is leading a new era in payment integrity by providing the first and only solution that offers a single platform for all third-party editing tools, delivering a unified view of the payment integrity workflow across the enterprise.

To learn more about taking an enterprise approach to payment integrity, download the full research report, "A New Paradigm Shift in Payment Integrity," and discover how HealthEdge can help your organization achieve its payment integrity goals.