Gartner Research

U.S. Healthcare Payer CIOs Must Adopt Prospective Payment Integrity to Thwart Improper Claims Payment and Fraud

Published: 13 February 2018

ID: G00350050

Analyst(s): Mandi Bishop , Bryan Cole

Summary

Improper claims payment and fraud contribute more than $200 billion to the annual cost of U.S. healthcare, yet few payers attempt to proactively plug their leaks. Payer CIOs must get proactive and leapfrog current performance by focusing on prospective payment integrity capabilities.

Table Of Contents

Analysis

  • Recommendations
    • Evaluate the Current Value of Payment Integrity Efforts Across the Enterprise
    • Find Common Objectives and Metrics for Payment Integrity Across Your Organization
    • Issue an RFP to Evaluate Vendor Capabilities

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