PAYMENT INTEGRITY OFFICE
Our Approach
Craft a Payment Integrity operation from the ground up, infusing it with the magic touch needed to unearth over $100 million in potential annual medical expense savings for a health plan, like a financial wizard conjuring up a treasure trove of opportunities.
The Outcomes
Established a comprehensive Payment Integrity program
Achieved annual medical cost savings exceeding $150M
Realized remarkable 5:1 ROI
Identified over 4% of members with other primary coverage
Exceeded industry standard recovery rates
Developed a gold standard Special Investigations Unit (SIU)
Attained breakeven in under a year from program initiation
Cultivated Payment Integrity culture within the organization