As Medicare and Medicaid oversight intensifies, health plans are navigating a more complex landscape where policy ambiguity, state variability, and heightened enforcement are exposing gaps between intent and execution.
Prepay strategies are gaining momentum as they prevent avoidable spend before claims are paid. But implementation is rarely simple and post-pay still has a clear role in a layered strategy.
This webinar explores why health plans are shifting toward earlier intervention in the face of legal pressure and financial risk, strengthening audit defensibility, contract protections, and decision transparency to stay ahead of scrutiny.
You’ll learn:
- Clear separation of regulatory headlines vs. operational reality
- Understanding how policy changes actually impact payment integrity workflow
- Practical strategies to reduce risk and maintain provider relationships while shifting to prepay claim review