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
