Boston, October 27, 2016 – The structural changes to the U.S. health insurance payments system aim to cut waste and shift the focus back to care delivery, but the payments system is in flux and ripe for honest errors and criminal intent. Health plans viewing payment integrity as an enterprise-wide core competency will strengthen network and member relationships, contain costs, drive solid policy decisions, and protect and grow the brand, and their need for analytics has never been stronger.
This research examines the headwinds and tailwinds impacting the payment integrity industry, develops the scope of payment integrity solutions and services, and summarizes 14 prominent players’ offerings: Ayasdi, CGI Group, Context4 Healthcare, Equian, EXL, Experian, Fair Isaac Corporation (FICO), HCL, Hinduja Global Solutions (HGS), LexisNexis Risk Solutions, McKesson, Optum, SAS, and Verscend. It is based on 16 interviews with payment integrity and fraud analytics vendor executives serving the government, commercial, and employer self-funded health plan marketplace.
This 46-page Impact Report contains 16 figures and four tables. Clients of Aite Group’s Health Insurance service can download this report, the corresponding charts, and the Executive Impact Deck.
This report mentions Aetna, Anthem, BAE Systems, Blue Cross Blue Shield Association, Blue of California, CareFirst, Centers for Medicare and Medicaid Services (CMS), Centerview Capital, Change Healthcare, Cigna, Citi Ventures, Cognizant, Corbel Solutions, Cotiviti, DraperNexus, Excellus, Floodgate, General Dynamics, Healthcare Fraud Shield, HMS, IBM, Institutional Venture Partners, Khosla Ventures, Kleiner Perkins, Microsoft, Premera Blue Cross, RELX Group, Rollins, RPM Direct, Stanford University, Trover Solutions, Truven Health Analytics, UnitedHealth Group, Verisk Analytics, Veritas Capital Management, and Xerox.