Payment Integrity Best Practices for Regional Health Plans and TPAs

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Timely and accurate payments to providers are essential to the success of regional health plans and third-party administrators, mitigating friction and improving operational efficiency for health systems, hospitals, and physician practices. Effective payment integrity efforts — ensuring claims are paid accurately in both pre-pay and post-pay contexts — hinge on a payer’s ability to determine eligibility, meet the requirements of contracts, and avoid fraud, waste, and abuse. With future innovations in care design requiring greater collaboration between payers and providers, health plans and TPAs must do their part to increase transparency and information sharing around payments to combat provider abrasion and build trust.

As Director of Payment Integrity at Regence, Shelley Dean manages comprehensive programs designed to adjudicate and pay claims more efficiently. In a recent HealthPayerIntelligence webcast, Dean will described the strategic importance of payment integrity efforts to make healthcare more streamlined for both providers and members.

Oct 7, 2022
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