A Single-Vendor Approach May Improve Your Payment Integrity Program

A Connected, End-to-End Payment Integrity Approach

Consolidating PI solutions under a single vendor can provide a connected, end to end system with the ability to deliver several operational and financial benefits over a multi-vendor approach. Here are five.

1. An Intelligent Payment Integrity Program

With multiple vendors, each vendor sees only a slice of the claims data, which can limit the effectiveness of AI models, reduce predictive accuracy, and create blind spots that can cause leakage. However, if a single vendor has access to data for both pre-pay analysis and post-pay audits, the payment integrity program has the ability to become smarter:

• Insights from post-pay reviews can be used for pre-pay prevention.
• Machine learning models can train on broader, more complete datasets.

2. Streamlined Operations

Managing multiple vendors often means juggling multiple:

• Contracts
• Service-level agreements
• Portals
• Support teams
• Implementations

With one vendor, multiple versions of the items listed above are replaced with one, helping to streamline operations and reduce the administrative burden.

3. A Better Provider Experience

Many healthcare payers prioritize positive provider relationships, yet a multi‑vendor payment integrity model can inadvertently create provider abrasion because of:

• Repeated requests for the same medical records
• Overlapping audits on the same claim
• Conflicting determinations

A single vendor can reduce these issues by coordinating outreach and presenting unified findings.

4. Streamlined Reporting

With multiple vendors, payers may have to access several dashboards to see reports relating to their payment integrity results. This may make it more difficult to understand how the program is performing overall.

With one vendor, there is one dashboard and it’s easier to see savings.

5. Lower Total Costs

Beyond performance gains, using one payment integrity vendor can provide immediate cost efficiencies:

• Bundled pricing
• Reduced implementation work
• Lower administrative overhead
• Elimination of redundant vendor fees

Clarity in Action

Payers that work with one vendor for all their payment integrity needs can gain several advantages over their competitors that use a multi-vendor approach to payment integrity. The potential advantages extend beyond better savings and include streamlined operations, less provider abrasion, and a connected program poised to transform the program from recovery to prevention as discoveries made during post-pay are used to improve pre-pay solutions.

Claritev offers a full suite of pre- and post-payment and revenue integrity solutions that span a claim’s lifecycle. These solutions include:

• Advanced Code Editing
• Clinical Negotiation
• Coordination of Benefits
• Itemized Bill Review
• Subrogation
• Data Mining
• Medicare Secondary Payer Validation
• End-Stage Renal Disease Premium Restoration

These solutions can be used together, allowing insights gained during post-pay recoveries to be utilized in concert with our pre-pay solutions to help prevent errors from occurring again.