Resolve Waste and Abuse Before Payment
Most payment integrity solutions rely on automation of published edits and policies, leaving significant errors – and in particular waste and abuse – on the table. MultiPlan’s Healthcare Payment Integrity services combine automation with expert review. Between analysis and payment we pause to examine, so we can complement existing programs by targeting complex issues like contradictory or overlapping services and suspect billing patterns, that aren’t addressable by computer alone.
Our analysis of hundreds of millions of paid commercial claims from a variety of payers proves that even when sophisticated editing is in place, MultiPlan's payment integrity "factors" find significant additional opportunities for savings through removal of charges billed in error. About 30% of these are National Correct Coding Initiative (NCCI) edits missed by the payers' systems while the vast majority are overpayments from--intentionally or unintentionally--exploited loop holes not easily addressed in standardized coding approaches.
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