The COVID-19 crisis created rapid changes in healthcare delivery and billing practices, increasing the risk of inaccuracies and inefficiencies. As new treatment protocols, coding updates, and regulatory shifts emerged, healthcare payors faced heightened pressure to detect errors, maintain compliance, and ensure payment accuracy in an evolving environment.
Healthcare payers face constant pressure to control costs in an increasingly complex and fast-moving environment. Success depends on three critical attributes: customization, flexibility, and speed to market. By tailoring solutions to unique organizational needs, remaining agile in response to change, and rapidly deploying effective strategies, payers can better manage costs while maintaining accuracy, efficiency, and member satisfaction. [claritev.com]
Technology has played a critical role in helping organizations maintain operations during challenging times. From enabling remote work for the majority of employees to supporting telemedicine growth and enhancing provider communication through digital portals, these tools have simplified complex workflows, improved access to care, and ensured business continuity in a rapidly changing healthcare environment.
Healthcare payors are navigating uncertainty in the “new normal,” facing challenges like shifting claim volumes, cost pressures, and limited resources. By leveraging flexible, customizable building blocks—such as network-based, analytics-driven, and payment integrity solutions—organizations can adapt to change, maintain financial control, and strike a balance between cost savings, provider relationships, and member satisfaction. [claritev.com]
Managing a Medicare Advantage network involves complex, resource-intensive tasks—from ensuring adequacy and compliance to credentialing, provider support, and reporting. By offloading these seven network-based functions to a trusted partner, healthcare payors can streamline operations, maintain regulatory alignment, and focus on strategic priorities while improving network performance and efficiency.
Machine learning is helping drive efficiency and accuracy across healthcare operations by enabling systems to learn from data and automate complex processes. At Claritev, this technology is used to prioritize claim reviews and enhance payment integrity, allowing teams to focus on high-value tasks, reduce manual effort, and scale operations while delivering greater value to clients.
Strong provider relationships are the foundation of effective healthcare networks. By leveraging long-standing partnerships, deep provider insights, and an extensive network, healthcare payors can build compliant, high-performing networks faster—improving access to care while maintaining efficiency, flexibility, and strong collaboration across the healthcare ecosystem.
MultiPlan’s 2018 Rural Health Grants supported four hospitals in expanding care access and improving outcomes in underserved communities. From dementia education and wound care certification to mobile mammography and heart failure support programs, each recipient used funding to deliver innovative services and strengthen healthcare access where it’s needed most.