Shifting left: Redefining payment integrity in a smarter, more connected health system

Health systems worldwide are undergoing significant change, and payers are at the center of that transformation. Their role now extends far beyond processing claims. According to CGI’s 2025 Voice of Our Clients research, financial resiliency and cost optimization are top business priorities for health and life sciences executives, and today, payers are shaping the financial, operational and technological foundations of modern healthcare. They’re driving affordability, elevating health equity, and enabling more proactive, person-centered models of care.

In this new landscape, payers are no longer administrators of transactions; they are architects of sustainable, data-driven systems that balance affordability, equity and outcomes.

Shifting left: Moving from detection to payment precision

Payment integrity sits at the core of payer performance, yet many organizations still rely heavily on post-payment audits to identify errors and recover overpayments. This reactive model is costly, slow and often creates friction across the ecosystem. To address these challenges, the industry is adopting a more proactive “shift left” approach: shifting payment integrity activities earlier in the claims lifecycle to ensure accurate claims payment.

Historically, it was easier to process claims now and fix them later. However, this approach increases administrative burden, rework and tension with providers. Shifting left means reviewing claims earlier, before payment, or even before submission, so claims are accurate the first time.

Powering shift-left: Real-time intelligence driving efficiency, trust and scale

Shifting left is a mindset shift toward earlier intelligence and precision. Instead of reacting to inaccurate claims, misaligned coding, or unnecessary rework, payers are increasingly focused on identifying and addressing issues before they occur.

The next horizon is provider enablement. By collaborating upstream, payers and providers can support coding accuracy before submission. Whether integrated into portals or deployed via clearinghouses, this approach reduces rework for both sides and supports a smoother, more predictable financial experience.

For example, CGI ProperPay supports a more proactive approach by connecting payers and providers through an integrated platform to achieve medical claim coding precision. An integrated platform promotes transparency, increasing trust between payers and providers, while configurable rule libraries and AI-driven insights empower payment integrity teams. This streamlined approach allows payers to increase insourcing activities without slowing processing or jeopardizing prompt-pay requirements.

A global shift toward upstream payment accuracy

While the U.S. has historically led in post-payment analytics, the shift-left movement is accelerating worldwide. Regions are adopting upstream payment accuracy in ways that reflect their governance models, digital maturity, and provider ecosystems.

• Canada: Provincial e-claim platforms such as Teleplan, H-Link and OHIP and maturing provider services, create strong foundations for upstream accuracy.
• Germany: While statutory post-payment reviews remain central, advancing digital rails support earlier documentation and pre-dispute accuracy checks.
• France: SESAM-Vitale and NOEMIE open opportunities for explainable, pre-submission validation.
• Nordics (Denmark, Finland, Sweden): Highly digitized ecosystems enable real-time validation and expanded pre-disbursement edits.
• Australia: Through HPOS and Webclaims, the system already supports near-real-time adjudication, making AI-enhanced validation a natural next step.
• United Kingdom: NHSBSA’s pre-payment checks in dental and pharmacy services demonstrate potential for broader rule-based validation.
• Estonia: Deep integration between national insurance and provider EHRs provides a model for embedded eligibility and tariff validation.

Across markets, the trend is consistent: data integration, intelligent validation, and payer-provider collaboration support more accurate payments the first time, even if implementation differs by region.

What comes next in payment integrity transformation?

The future of payment integrity is proactive, collaborative and intelligent. Organizations that invest now in shift left capabilities will be positioned to reduce costs, improve relationships, and support more sustainable health systems.

We partner with payers worldwide to make this shift real. Using unified data platforms, intelligent automation, and responsible AI, we help teams move proactively rather than reactively. Our work spans modernizing legacy platforms, deploying responsible AI, and creating intelligent workflows that make health financing more transparent and sustainable.

With solutions such as CGI ProperPay, AI for Prior Authorization, and Pulse AI, we help payers achieve measurable improvements in accuracy, operational efficiency, and member engagement.

For a conversation on shift-left trends and solutions, contact me. I also invite you to meet us at ViVE 2026 and to schedule a discussion on next-generation payment integrity.