In the complex world of healthcare claims, this white paper explores the lifecycle of a policy within Lyric’s ClaimsXten solution, detailing how policies are created, tested, and implemented to ensure accurate and efficient claims processing. Through robust examples and a deep dive into the policy development process, health plans can significantly enhance payment accuracy, reduce fraud, and ensure compliance with evolving regulations.

The healthcare landscape is evolving at an unprecedented pace, challenging traditional approaches to payment integrity. As health plans navigate the shift towards value-based care models, rising costs, and increasing regulatory pressures, their payment integrity (PI) strategies must remain competitive and effective.

The healthcare industry is undergoing a profound transformation. Traditional payment integrity methods, centered around medical savings and cost-cutting, are giving way to a broader perspective on value. This new approach prioritizes enhanced care quality, streamlined payer-provider interactions, and greater trust among stakeholders.

The healthcare industry faces mounting challenges, from soaring costs to regulatory requirements and a need for operational efficiency. Health plans are feeling the pressure to adapt to these changes while maintaining a focus on quality care and member satisfaction.

The integration of emerging technologies like artificial intelligence (AI) necessitates a nuanced approach to medical billing and coding. Category III CPT codes, facilitate the tracking and analysis of these innovations. Learn how these codes interplay with AI-driven services and their implications for healthcare providers and health plans.

At the ViVE Payer Insights Program, speakers shared views on progress with AI, prior authorization provider readiness and infrastructure challenges, and more. As a panelist, Tawfiq Bajjali, Lyric’s General Manager of Platform Solutions, shared his views on the benefits of AI-enabled platforms.

October 2023: Read the first KLAS report to focus on payment accuracy and integrity solutions.