As benefit consultants help their employer clients comply with new federal transparency regulations, greater attention is being paid to an important subset of that issue known as payment integrity. This emerging area involves more than just ensuring that medical bills are accurate; payment integrity (PI) examines all aspects of the billing and claims paying process.
The result of a PI review and ongoing analysis should be the elimination of errors (and abuse, in some cases), as well as peace of mind for the plan sponsor. While payment integrity does not normally focus on third-party administrators (TPA) or other claims paying activities, occasional errors there can be caught as well.
