How can health plans gain greater visibility into payment integrity?
As payment integrity ecosystems grow more complex, health plans face a critical challenge: a fragmented view of how decisions, performance and outcomes connect across the claims life cycle. New research from Everest Group examines how leading plans are shifting from restrictive “black box” vendor models to transparent, high-visibility operations to strengthen oversight and accountability while continuing to leverage the specialist capabilities and operating models already in place.
Inside the report
Approximately 55% of healthcare payers surveyed by Everest Group “ranked the shift from black-box to white-box payment integrity as one of the top two trends shaping the market.”
- Uncover hidden blind spots: See why comprehensive, end-to-end visibility has shifted from a competitive advantage to a non-negotiable priority for health plan leaders.
- Strengthen vendor oversight: Discover frameworks to hold multiple partners strictly accountable to performance targets without shifting the administrative or execution burden in-house.
- Drive continuous improvement: Map out a practical, phased transition from basic data visibility to high-impact, proactive intervention.
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Turn payment integrity insight into action
Greater visibility gives health plans a clearer view of what drives payment integrity performance and where to act. Connecting insights across prepay, postpay and recovery helps teams identify recurring issues, prioritize interventions and use findings to improve future payment decisions.
At CGI, we bring together technology, analytics, domain expertise and specialized services to help health plans put those insights to work. We combine AI-enabled capabilities with clinical and payment integrity expertise to strengthen payment accuracy and operational effectiveness throughout the claims life cycle.
