This roundtable discussion highlights the multifaceted approach required to navigate the complex landscape of payment integrity. As we move into 2025, these insights from top executives provide a valuable roadmap for the industry.
Q1: What do you see as the biggest obstacles health plans face in building effective payment integrity programs?
Greg (President): There are many headwinds for health plan execs as we move into 2025, and we continue to see staffing shortages and high turnover as one of the things our clients report. These issues are compounded by the need for more accurate claims processes and the growing complexity of the healthcare ecosystem. At CERIS, we’re addressing this by leveraging technology to help our clients fill staffing gaps and enhance process accuracy
and efficiency.
Rick McLaughlin (Accounts): Another significant obstacle continues to be administrative burden. For example, organizations with limited vendor support often struggle with excessive claims management workloads. To address this, a strategic mix of internal expertise and external vendor partnerships can help reduce friction and improve outcomes.
Jhana (Strategy): The increasing complexity of claims adjudication processes is another major hurdle. At CERIS, we focus on streamlining workflows through innovative tools and creating client-specific solutions that help health plans navigate these complexities with ease.