Gartner Research

Market Guide for Payment Integrity Solutions for U.S. Healthcare Payers

Published: 09 March 2016

ID: G00293400

Analyst(s): Constance Sjoquist


The increasing prevalence and cost of fraudulent or otherwise improper medical claims payments has a serious impact on a healthcare payer's reputation and revenue. CIOs need to implement technology-based solutions to detect, prevent and mitigate improper claim activities and payments.

Table Of Contents

Market Definition

Market Direction

  • Gartner 2016 Survey of Payment Integrity Vendors
    • Zero Tolerance
    • Advanced Analytics
    • Special Investigations
    • Smart Machines
    • Reducing Administrative Costs

Market Analysis

  • Payment Integrity Vendor and Market Size
  • The Value or Outcomes That Payers Should Expect From Payment Integrity Vendors
  • How Vendors Charge for Their Solutions
  • How Vendors Approach Payment Integrity in Payer Operations

Representative Vendors

  • ACL
  • Change Healthcare
  • CGI
  • Dell
  • FICO
  • FraudLens
  • General Dynamics Information Technology
  • IBM
  • LaunchPoint (including its two divisions: Discovery Health Partners and Ajilitee)
  • Optum
  • SAS
  • Truven Health Analytics
  • Verisk Health
  • Xerox

Market Recommendations

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