What is on the horizon for healthcare payer technology in 2025? In this annual report, ClarisHealth experts review the trending drivers – and associated opportunities – so health plans can innovate payment integrity while minimizing risk.
Search Results
Cost Containment
Maximizing Opportunity with 2025 Healthcare Payer Technology Trends
Managed Medicaid Plan Finds Technology Partner to Grow Payment Integrity Savings
Kern Health Systems selects Pareo® One technology-enabled payment integrity services to shore up claims accuracy efforts. Using an integrated, provider-first approach, ClarisHealth auditors identify $3M in first 9 months for the Medicaid MCO.
Payment Integrity Leaders Reveal What Will Move the Industry Forward
Payment integrity leaders from the country’s top health plans take time to collaborate at POP Conference 2024. They find strength in community, innovative ideas, and a focus on 4 primary industry drivers.
Health Plan Leaders Speak Out on Building the Payment Integrity Organization of Tomorrow
Whether or not health plan leaders implement a fully centralized PIO, sharing information on an enterprise payment integrity technology platform helps overcome challenges and meet strategic opportunity.
A Better Way to Conduct Medical Claims Audits
With advanced technology, health plans can take control of their medical claims audits while achieving high ROI. Here’s how.
Vendor Consolidation Reduces Payment Integrity Innovation
What steps should your health plan take to ensure you get the most value from your services vendors and payment integrity efforts in the face of vendor consolidation?
Strategies to Move Your Payment Integrity Program Prospective
Payment integrity evolves into a more strategic function for health plans in order to reduce overall healthcare expense. Prepay drives greater cost savings but can be difficult to achieve. Here, we share strategies that can enable prospective cost avoidance programs...
Are You Hurting Provider NPS with Your Payment Integrity Efforts?
Look out for these 4 elements of payment integrity that may negatively impact provider NPS (net promoter scores) with your network providers. The Net Promoter Score (NPS) – an established metric traditionally managed by insights and marketing departments – can drive...
The Strategic Approach to Claims Cost Containment
Competing with other health plan functions for technology priority can lead to missed audit claims cost savings potential. An integrated payment integrity strategy breaks down these internal silos. With so many moving – and vital – parts within a payer organization,...
How to Evaluate Payment Integrity Solutions: The Ultimate Guide for Health Plans
Payment integrity solutions vendors make many claims. Here are the top 14 areas of evaluation to ensure a perfect fit for your health plan. Virtually every health plan is looking to address shrinking margins by moving their medical savings from a typical 1-2% today to...
Increase Agility Around These 3 Hot Button Issues to Minimize Risk in Healthcare and Politics
The 2020 presidential election is upon us, and the debate surrounding healthcare and politics is more contentious than ever. How can your health plan stay ahead of the game, no matter the outcome? Every 4 years, the cross section of healthcare and politics is put on...
Your 5 Point Clinical Audit Checklist to Reduce Provider Abrasion
In part 2 of our series we outline exactly what health plans should look for in an advanced technology platform for clinical audit Paying claims right the first time – while making the most of internal resources – is the primary goal at most payer...
Diving Deeper into Healthcare Claims Audits: Part 1 – Auditor Workflow
The first installment in a multi-part series aimed at clinical auditors. Part 1 takes a closer look at 5 trends impacting how health plans manage claims auditing today. Claims auditing. It’s the core function of any health plan payment integrity operation. Ensuring...
Why we focus on the problem, not the health care solution
ClarisHealth CEO Jeff McNeese shares how our tech company created a solution born directly out of the frustrations with the healthcare industry, by experienced healthcare workers. A major health plan client came to us recently and asked “Can you partner with us on...
An Aggressive Plan to Move your Claims Recovery to Prepay Status
Transitioning more payment integrity operations to internal prepay is more than just a pipe dream for health plans Transitioning prepay. It’s the holy grail for health plans — and viewed as equally unattainable. And, in the not-so-distant past, this viewpoint would...
Managing Medical Record Requests a problem? We’ve got the solution.
How to manage medical record retrieval processes with multiple clinical audit vendors.Is your health plan missing out on the potential of having multiple clinical audit vendors because you’re concerned about overlapping medical record requests? That uncoordinated...
Modernizing communication with providers
Time to move past playing telephone with providers. Here’s a better communication strategy for health plans. By relying on fax machines and snail mail to communicate overpayments, underpayments, denials, and just about everything else, the payer-provider relationship...
What makes value-based care programs work? 3 keys to success
Following up on our previous article, we look more closely at what successful value-based care initiatives have in common. It’s not all that surprising that one of our recent blog posts, Medicare for All: Should it be feared by health plans? has quickly become one of...
Medicare for All: Should It Be Feared by Health Plans?
Worried about “Medicare for All”? You certainly aren’t alone, but health plans could view this as an opportunity. 6 Myths and facts revealed. Proposals for single-payer healthcare models — sometimes termed “Medicare for All” — top today’s healthcare news. Strong...
Lack of Documentation is a $23 Billion Overpayment Problem for Medicare
Medicare overpayment is a massive problem, and lack of documentation is a significant contributor. When we see errors adding up to billions of dollars in improper payments, we pay attention. As payment integrity technology experts and also healthcare consumers we take...
6 Signs of Outdated Payment Integrity Processes
Working harder and harder for a 1-2% rate of return on claim spend? It’s time to update your health plan’s payment integrity processes. Today, health plans and payers are at a crossroads: margins are shrinking, members are savvier, providers are increasingly...
Top 10 Ways to Maximize Your Health Plan’s Recoveries
Want to maximize your health plan’s recoveries? Of course you do. Here’s how.There’s a great deal of uncertainty in healthcare today, but one thing never changes: health plans’ desire to grow their recoveries. But, stuck dealing with insufficient technology or...
Provider to Health Plan: It’s not me, it’s you.
Are you playing a costly game of “Who’s got the medical record”? 90% of your health plan’s cost containment efforts are the source of provider friction. Your health plan has one directive: control medical spend. And despite tight timelines, a shortage of skilled...
Claim Spend – Is It Too High at Your Health Plan?
Examining claim spend cost at health plans, and what kind of ROI can be expected. Controlling claim spend is nearly impossible without system visibility. By that, we simply refer to the access that some technology gives health plans and payers into payment integrity...
Addressing the $330 Billion Elephant in the Room: Administrative Complexity
Health plans can minimize wasteful spending on administra Administrative Complexity: Complex administrative processes in healthcare organizations that are increasingly seen as unnecessary and are therefore leading to wasteful spending. Nearly 10% of the $3.3 trillion...
How to Reduce Administrative Costs for Coordination of Benefits
Make Your Processes More Efficient for COB Cost Savings It has been estimated that the administrative costs for coordinating benefits is $800 million. Let that sink in for a second – $800 million is a lot of money to spend on a process that can be improved. Other...
Best Payment Integrity Results at The Most Optimized Cost
Integrative Audit and Recovery Solution Offers Top Value for Healthcare Payers Many of the healthcare companies we speak with often express concern when reconciling the concept of comprehensive payment integrity with day-to-day operational stressors, such as lowering...
Are You Doing Enough to Avoid and Recover Payment Error Leakage?
Most health plans think they have it covered with a claim editing solution, internal payment integrity efforts, or a vendor or two. But what are the real results, and how does that compare to the industry? There’s no doubt that the healthcare industry is in the midst...