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Medical Payment Integrity Services 

Improving payment accuracy for medical claims

 

Medical Payment Integrity
Automation combined with expert clinical review targets complex waste and abuse.

Dental
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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

  • • Reduces medical spend
  • • Improves payment accuracy
  • • Minimizes provider abrasion
  • • Complements existing repricing solutions
  • • Evolves with creative billing schemes
  • • Delivers intelligence to internal SIU departments

 

 

More Value Through Deeper Analysis

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.

 

 

Unique Position, Different ApproachOnly MultiPlan brings a cost management heritage to medical & dental payment integrity. We know payment integrity, we know providers, and we know pre-payment. Let us take your historically retroactive process upstream, and ensure that lost claims savings no longer go unnoticed. Download our Payment Integrity White Paper