ClarisHealth Reveals Key Operational Performance Benchmarks for Payment Integrity Programs

Program performance benchmarks showcased at inaugural Power of Payment Integrity Conference gathering of leaders from 35 health plans

NASHVILLE, Tenn., April 22, 2025 – Today ClarisHealth revealed key operational and savings benchmarks for health plan payment integrity programs. The research was shared during a keynote presentation at the Power of Payment Integrity Conference, the industry’s only peer-led payment integrity conference. Key among these insights included targets such as 5.6% savings as a percentage of medical spend and 61.9% prepayment recovery rate.

“The future of payment integrity lies in leveraging data to move beyond reactive measures,” commented Thomas Baggett, Jr., senior director of operations and client success for ClarisHealth, who led the research. “What we shared today, including savings as a percentage of medical spend, prepayment recovery rate, and PMPY savings amounts for select payment integrity functions, demonstrates the potential for health plans to achieve higher levels of efficiency and savings.”

The industry experts at ClarisHealth, provider of Pareo® the only integrated platform for payment integrity operations, validated the benchmarks based on proprietary data and research gathered from more than 25 health plans.

“Even though health plans have access to mass quantities of data and discrete savings metrics from individual service vendors, there are still blind spots,” said Baggett. “By releasing these benchmarks, we hope to provide payment integrity leaders with the ability to shine a light on those blind spots and do a comparative analysis for a well-informed, data-driven decision-making process.”

Operational benchmarking that helps payment integrity leaders measure program success is made possible only through an integrated audit inventory management system.

“Every payment integrity leader is looking to more fully utilize their program to maximize savings and minimize provider abrasion,” said Sara Thomas, vice president of payer strategy for ClarisHealth, who supported the research. “With an integrated view of your data from across your operation, you may discover you’re only auditing a small percentage of your overall claims, or missing identified savings opportunities that were ultimately never recovered. Taken in combination with these industry benchmarks, that’s a powerful perspective.”

The inaugural Power of Payment Integrity Conference this week convened leaders from 35 health plans from across the country seeking best practices and innovative solutions from their peers and other industry experts. Chief on the agenda is how to use technology to standardize claims audit data and advance payment accuracy strategies.

“We encourage health plans to baseline their own data. Examine performance, evaluate wins and gaps, and decide which options to discard or develop further,” said Baggett. “These benchmarks are just the beginning. The goal is for the community to work together on a reliable and common set of standards that elevates the entire industry.”

For more information on ClarisHealth’s Power of Payment Integrity Conference, please visit www.clarishealth.com/events/pop-conference/.