The analytical horsepower required to make sense of more and more data means technology partners must invest in their capabilities.
Boston, May 4, 2021 — A consolidating competitive landscape, a slew of regulatory shifts and changes, and a raft of technology advances offer payment integrity vendors both opportunities and challenges in the healthcare space. A range of other factors—from integrating acquisitions into one cohesive product offering, the increasing need for robust data, the aim to reduce provider abrasion, an emphasis on increasing the level of payment accuracy, and the attention on emerging business and reimbursement models—will constitute the road signs on the path ahead for payment integrity.
"The transformation from pay-and-chase to prevent and pay, along with the shift from paper and manual to digital and automated in healthcare claims, is a long way from being complete," says Inci Kaya, senior analyst at Aite Group. "Technology vendor partners have been investing heavily in data analytics capabilities, artificial intelligence, user-friendly features, and functionality and integration to move the industry forward on that front. Mergers and acquisitions in the payment integrity field have also meant operational efficiencies as well as product and cost rationalizations, resulting in a profitable business environment for vendors," she explains.
This Impact Report evaluates the payment integrity market, lists key market trends affecting payment integrity specific to healthcare claims, and sizes the market using multiple metrics. The report also discusses the drivers that fuel as well as hinder adoption of payment integrity and payment accuracy solutions. It is based on discussions with leading vendors as well as active end clients and other key players participating in this technology market ecosystem; a forthcoming Aite Matrix report will provide a formal evaluation of leading payment integrity vendors through Aite Group’s proprietary vendor assessment framework.
This report mentions Centers for Medicare and Medicaid Services, CGI Group, Equian (acquired by Optum), Change Healthcare (acquired by Optum), ClaimLogiq, ClarisHealth, Codoxo, Cotiviti (acquired by Veritas Capital Fund Management), Discovery Health Partners, EXL Service, Experian Health, Healthcare Fraud Shield, HMS (acquired by Gainwell), IBM Health, Integrity Advantage, LexisNexis Risk Solutions, Mastercard Health Solutions, Multiplan, Optum Financial, Qlarant, Performant, SAS Institute, SCIO Analytics (acquired by EXL Service), Shift Technologies, Truven Health (acquired by IBM), and Zelis.
To request a press copy of this report or to speak with Inci Kaya about this topic, please contact us at [email protected].
About Aite Group:
Aite Group is a global research and advisory firm delivering comprehensive, actionable advice on business, technology, and regulatory issues and their impact on the financial services industry. With expertise in banking, payments, insurance, wealth management, and the capital markets, we guide financial institutions, technology providers, and consulting firms worldwide. We partner with our clients, revealing their blind spots and delivering insights to make their businesses smarter and stronger. Visit us on the web and connect with us on Twitter and LinkedIn.
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