In the evolving landscape of healthcare payment and integrity, claims editing emerges as a pivotal component, ensuring the accuracy and efficiency of bills submitted by care providers and provider organizations (“providers”). For health plans and those vested in payment integrity, understanding the nuances of this process is crucial.

In the fast-evolving and intricate landscape of payment integrity, the value of prepay editing is paramount. As powerful AI and advanced analytics are being applied earlier in the claim adjudication process, the importance of next generation claim editing capabilities will separate health plan leaders from laggards.