Payment integrity

It’s the perfect time to evaluate your payment integrity technology

For many health plans, payment integrity is able to influence the bottom line in powerful ways. For payment integrity organizations (sometimes called cost containment), the new year is the perfect time to evaluate what has been working well and what can be done better and more efficiently.

Transforming payment integrity with transparency

As the healthcare industry continues to transform, it has become clear that the need for increased transparency is one of the critical drivers of change. Health plans are being asked to share more information with a broad range of stakeholders in an effort to control costs and drive improvements in efficiency.

The right eligibility data management solution

Addressing eligibility data management can seem like an overwhelming or impossible task among all of your other competing priorities. However, fixing these data errors can eliminate downstream impacts to your payment integrity programs that are likely costing your plan millions of dollars.

The eligibility impact: How and why eligibility data issues affect payment integrity

Over the last two months, we’ve examined how organizational and technology structures can keep health plans from recognizing, understanding, and resolving their payment integrity challenges. This month, we want to spend a little time examining one thing that can be at the root cause of some of those challenges: eligibility. Eligibility issues impact a multitude

Discovery discuss payment integrity solutions at ACAP CEO Summit

Annual gathering addresses challenges facing Medicaid managed care plans ITASCA, IL (June 8, 2015) – Discovery Health Partners, a division of LaunchPoint, will participate in the annual Association for Community Affiliated Plans (ACAP) CEO Summit June 15 – 16 in Washington, D.C.  The annual invitation-only meeting of community health plan executives is ACAP's signature event

Lack of information transparency and benchmarks hampers the payment integrity organization

By Bill Whittemore, vice president of Ajilitee, Discovery Health Partners’ sister division   In my last blog post,  I discussed some of the challenges healthcare payers face related to their lack of transparency into recovery performance results at a program level. In this post, I’d like to dive deeper into the problems caused by lack of

Silos and insufficient technology challenge the payment integrity organization

By Bill Whittemore, vice president of Ajilitee, Discovery Health Partners’ sister division   Several months ago, I wrote a blog post discussing the challenges that cause health plans to lose money on their claims payment integrity programs. In this post, I’d like to dive deeper into the problems caused by insufficient technology and dispersed payment integrity

Organizational complexity within health plans leads to claims payment integrity challenges

  In their ongoing efforts to manage costs and improve profits, many health plans are turning to the area of claims payment integrity, where plans are finding opportunities to reduce annual claims expense by millions of dollars. Despite the compelling business case for payment integrity, many health plans find that organizational challenges often mask these

The real cost of the payment integrity challenge

Clearly healthcare is the most interesting and dynamic sector in the U.S. today. We are witness to an unprecedented transformation as healthcare stakeholders embrace new delivery entities and new reimbursement models, shift attention to building relationships with members, and explore new markets. There will be winners and losers in this game, and everyone is placing