Healthcare payers are under growing pressure to control costs while maintaining strong provider relationships and member satisfaction. One proven way to achieve this is through a prepay strategy often referred to as “shifting left”. It’s about moving payment integrity checks to earlier in the claims process.
Traditionally, payers have focused on post-payment audits to recover overpayments. While this works, it often results in delayed savings, provider frustration, and missed chances to prevent errors. Shifting left changes that by bringing reviews, such as clinical validation, coding accuracy, and documentation checks, closer to the point of claim submission. This helps stop improper payments before they happen.
The benefits are clear. Prepayment reviews prevent revenue loss in real time, reduce the need for costly collections and appeals, and improve transparency with providers by addressing issues sooner. This approach also makes better use of technology, applying AI and predictive analytics to catch anomalies early.
Shifting left isn’t just a process change it’s an industry-wide mindset shift. It requires collaboration across teams, alignment with providers, and investment in smarter tools and clinical expertise. The payoff? Lower medical loss ratios, stronger provider relationships, and a more sustainable way to manage costs.
As healthcare evolves, payers who adopt this proactive approach will lead with efficiency and foresight and deliver value not only to their bottom line, but to the entire healthcare system.