Common Health Plan Payment Integrity Challenges
In the Claims Review Process
SYSTEMS
Utilization of multiple systems with varied interfaces typically impede productivity during health plan claim reviews
DOCUMENTATION
Retrieving clinical documentation for medical record reviews and itemized bill reviews is time-intensive and often produces PDFs requiring manual review
PEOPLE
Nursing shortages and widely varying average medical record review and itemized bill review times create staffing challenges
TIME
Timely filing requirements and consistently decreasing health plan payment integrity review thresholds require more productivity
