Gartner Research

Adopt Prospective Payment Integrity to Thwart Healthcare Fraud and Improper Claims Payment

Published: 24 September 2020

ID: G00734789

Analyst(s): Mandi Bishop

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 the leaks. Payer CIOs must get proactive and leapfrog current performance by focusing on prospective payment integrity capabilities.

Table Of Contents

Overview

Introduction

Analysis

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Note 1: Relationship Models

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