Health plans’ focus on cost reduction drives fresh look at payment integrity
Discovery Health Partners estimates that for healthcare payers, payment integrity problems cost 3-7 percent of their paid claim dollars every year. That means, for example, a 500,000-member health plan with costs averaging $3,600 per member per year will pay $1.8 billion in claims, of which $54-$126 million will be wasted expense.
Based on our work with more than 60 payment integrity clients and discussions with nearly three times as many prospects, we have documented eight trends worth watching in the next year.
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