Payment integrity is an integral part of healthcare delivery, maximizing the value patients receive for their healthcare dollar by helping ensure claims are paid accurately and reducing fraud, waste, and abuse. However, this requires specialized processes and teams to review large amounts of data in a short time, often putting strain on health plan resources.
With the introduction of artificial intelligence (AI), payment integrity is evolving rapidly. As payers seek to incorporate AI into their payment integrity solutions, finding the balance between human expertise and machine learning is critical. There is significant opportunity for improvement, but there is also real risk.
