Insights
Research, analysis, and points of view from people who've been inside Payment Integrity — not just studying it.
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A monthly briefing on the forces reshaping payment integrity — five stories an issue, and what each one means for payers and vendors.
Read the latest issueIndependent Dispute Resolution is an operations problem before it is a compliance problem.
Federal IDR has outrun the process built to handle it, and payers absorb the difference in staffing, in turnaround, and in determinations that land against them. This paper covers what payers control: eligibility and batching decisions, the evidence package, the offer itself, and the operating cadence that keeps one determination from setting a precedent.
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Why AI spending keeps rising — and improper payment rates don’t fall.
Health plans are investing heavily in AI for Payment Integrity. Yet improper payment rates remain stubbornly flat. This paper examines why — and what leaders should be measuring instead of the savings numbers everyone’s already chasing.
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