Payment Integrity
Identify, prevent, and recover improper payments across the claim payment lifecycle.
A comprehensive approach to payment integrity
Payment integrity is no longer just about chasing overpayments after the fact. Today’s environment requires a comprehensive, balanced, and proactive strategy — one that addresses errors before and after claims are paid.
Carelon combines pre-pay precision and post-pay recovery to reduce claims payment leakage, improve accuracy, and support financial performance. Our approach targets the root causes of improper payments, including coding errors, eligibility gaps, coordination of benefits, and liability misalignment, to help reduce waste without increasing provider abrasion.
We pair advanced analytics and deep data assets with experts who bring decades of experience in claim editing, clinical review, subrogation, coordination of benefits (COB), and fraud, waste, and abuse (FWA). Together, these capabilities help payers build a more efficient, transparent, and scalable approach to payment integrity.
Solve the biggest payment integrity challenges
Reduce claims leakage
Identify hidden errors across the claims lifecycle to help prevent unnecessary spend before it affects financial performance.
Minimize false positives
Apply precise analytics and clinical expertise to help improve accuracy and reduce unnecessary reviews.
Protect provider relationships
Balance savings with collaboration through transparent processes and clinically sound decision-making.
Manage financial performance
Access clear reporting and performance insights that demonstrate value and guide continuous optimization.
Payment integrity solutions
Explore solutions designed to strengthen payment integrity across the claims lifecycle — from identifying other liable parties to uncovering overpayments and recovery opportunities.
SUITE
Other Party Liability
Identify and validate responsible parties across claims, including coordination of benefits, subrogation, and workers’ compensation.
SOLUTION
Data Mining
Identify overpayments and savings opportunities while minimizing provider disruption through highly-refined algorithms and collaborative workflows.
Connect with our payment integrity experts
Contact us to explore the potential impact of our payment integrity solutions for your health plan.
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