A Needed Shift
Although healthcare payments continue to undergo major transformations, one thing is constant—the need for advancing payment integrity remains paramount for payers.
Every inappropriately paid claim represents a cost that takes away from resources that can be dedicated to member care, and errors continue to erode the payer, provider, patient relationship.
We live in a time where trust and credibility are being questioned more than ever. The culture of payment integrity needs to be focused not only on reducing the total cost of care but also on better patient outcomes and satisfaction. This needed shift includes better alignment between incentives and quality of care and better communication between payers, providers, and patients.
CERIS partners with many healthcare organizations and has witnessed positive changes in payment success drivers, evolving transparency, and provider partnerships. The process and tools involved across the entire provider billing and claims payment lifecycle continues to evolve, and new thinking is mandatory to continue to drive high value healthcare.
We internally worked together to put together this guide as our pulse on payment integrity in 2023. We will cover the following key insights:
- Transparency Challenges
- Transparency Builders
- Barometers of Success
- Payment Pressure Points
- Full Cycle PI Drivers
- Payer Provider Friction
- Payer Provider Union
We want to offer it to everyone looking to enhance their foundation for holistic payment integrity success and hope you find it useful.