Aite Matrix: Payment Integrity in Healthcare

Technology vendor partners can help health plans seeking to optimize their claims payment process uncover new opportunities.

Boston, May 26, 2021  Healthcare payers are on a quest to make informed decisions as they strive to streamline their claims processing and payment operations. Improving the quality of claims data that they receive from providers and intermediaries, along with smoothing out wrinkles in substantiating claims, is part of that quest as well. Payment integrity tools play an important role in these optimization initiatives.

This report provides a detailed overview and evaluation of those vendors as health plans consider the emerging capabilities that can benefit their audits, special investigations units, and claim processes. Leveraging the Aite Matrix, a proprietary Aite Group vendor assessment framework, this report evaluates the overall competitive position of eight vendors, focusing on vendor stability, client strength, product features, and client services. Participating vendors were asked to complete a detailed request for information composed of qualitative and quantitative questions, conduct a minimum 60-minute product demo, and provide active client references. The following vendors participated in this report’s Aite Matrix framework: CGI Technologies & Solutions, Change Healthcare, ClarisHealth, Codoxo, Cotiviti, EXL Service, OptumInsight, and SAS Institute.

This 95-page Impact Report contains 19 figures and 41 tables. Clients of Aite Group’s Health Insurance service can download this report, the corresponding charts, and the Executive Impact Deck.

This report mentions Experian Health, Gainwell, Healthcare Fraud Shield, HMS, LexisNexis Risk Solutions, Shift Technology, and Zelis.

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