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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 service combines 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 & minimizes provider abrasion

Complements existing repricing solutions & delivers intelligence to internal SIU departments

Improves payment accuracy & evolves with creative billing schemes

Automation combined with expert clinical review targets complex waste and abuse

More value through deeper analysis

Our analysis of hundreds of millions of paid commercial claims from a variety of payors proves that even when sophisticated editing is in place, MultiPlan’s 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 payors’ systems while the vast majority are overpayments from inadvertent or exploited loopholes not easily addressed in standardized coding approaches.

Our top five most baffling billings

Check out some of the crazier billings errors we’ve caught:

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A different approach for medical pre-payment claims review

Only MultiPlan brings a cost management heritage to medical and 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.