Medical Payment Integrity Services
Improving payment accuracy for medical claims
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Resolve Waste and Abuse Before Payment
Most medical payment integrity solutions rely on automation of published edits and policies, leaving significant errors behind. MultiPlan’s Medical Payment Integrity services combine automation with expert clinical review. Between analysis and payment, we add a level of human expertise to examine claims where appropriate. This complements MultiPlan’s robust analytical programs by targeting complex issues such as contradictory or overlapping services and suspect billing patterns that are generally not addressed by computer alone.
Medical Payment Integrity Key Benefits
Our analysis of hundreds of millions of paid commercial claims from a variety of payers proves that even when sophisticated editing is in place, MultiPlan's Medical Payment Integrity "factors" find significant additional opportunities for savings through removal of inappropriately billed charges.
On average, only 15% of these edits are National Correct Coding Initiative (NCCI) edits missed by the payers' systems while the vast majority are overpayments from inadvertent or exploited loopholes not easily addressed in standardized coding approaches.