Full Cycle Payment Integrity Drivers

Greg Dorn, President & Mark Johnson, SVP Product Management

August 01, 2023

A woman on a tablet looking at payment integrity reports

Payment Integrity Barometers of Success

Deeper Dive into The Pulse of Payment Integrity 


US Healthcare is a highly complex ecosystem with challenges that must be met. A Full Cycle Payment Integrity program is a comprehensive approach to managing and monitoring healthcare payments. This type of program provides a complete review of payment from start (provider billing) to finish (provider payment). It includes a range of activities and technologies, including data analysis, detection and prevention, policy development and enforcement, and provider engagement and education. By implementing Full Cycle Payment Integrity, healthcare organizations can expand transparency, accountability, and accuracy in the payment processes.

Payment pressure points excerpt from The Pulse on Payment Integrity:

  1. Prepay
  2. Post pay
  3. Analysis
  4. Policy
  5. Education

The 5 key factors of a Full Cycle Payment Integrity program include:

  1. Prepay solutions identify the detection of errors early in the process, control costs, improve compliance, reduce admin burdens, and improve patient experience.
  2. Post Pay solutions increase savings using additional data and provide information that supports the ongoing analysis of root causes and recovery.
  3. Data analysis from various sources such as claims, electronic health records, and other payment data, identifies trends, patterns, and anomalies.
  4. Policy development and enforcement promote accuracy, efficiency, and transparency in the payment process.
  5. Provider engagement, outreach, and education in the payment process ensure all stakeholders are informed and educated about policies and procedures.

End to end claim receipt, processing, adjudication and payment can be complicated and include multiple technology applications, edits, rules, and databases. End-to-end payment integrity is designed to strengthen payment accuracy at every touchpoint along the claim lifecycle. This deeper dive article looks further into the development and benefits of a Full Cycle Payment Integrity program initially outlined in our Pulse on Payment Integrity white paper. We hope our in-depth analyses continue to provide tools to help you enhance payment integrity success.

Let's partner to a clear path to greater accuracy and cost savings.

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