Payer Payment Integrity

Reduce costs by addressing root causes

In recent years, health plans looking to cut costs arising from improper payments have taken the shrewd step of shifting their focus from recovery to avoidance. At Chartis, our Payer Advisory has been leading this upstream charge, helping payers address root causes and optimize how vendors are leveraged for payment accuracy. By incorporating artificial intelligence and machine learning to automate data and analytics, payers enjoy powerful new ways to analyze claims, coordinate benefits, and develop strategies around pre-pay and post-pay. This isn’t just reducing administrative outlay and improving claims efficiency. It’s also transforming the relationship between payers and providers—from one typified by abrasion to one built on long-term partnership.

Related insights

More Payer Advisory Insights

Medicare Advantage enrollment continues to surge in an increasingly complex and competitive landscape

In our 2022 Medicare Advantage Competitive Enrollment Report, we identify key trends and implications for healthcare organizations.

Finding harmony: how a provider-sponsored health plan advanced payment integrity

Faced with a declining recovery rate, leaders of a provider-sponsored health plan needed immediate solutions to improve payment integrity without negatively impacting the parent health system.

Where costs meet outcomes: How Chartis helped a Medicaid MCO optimize hospital readmissions

Faced with a readmissions rate of 16% this managed care organization partnered with Chartis to reduce readmissions, advance post-discharge care, and rein in avoidable costs for its 1 million members.

Meet our Payer Payment Integrity leaders

Atul Pathiyal

Managing Partner and Leader, HealthScape Advisors

Atul Pathiyal co-leads HealthScape Advisors, a Chartis Company. He has more than 25 years of advisory experience spanning the payer-provider continuum with a particular focus on designing new business models that harness the massive shifts shaping the healthcare industry.

Colin Blaney

Senior Partner, HealthScape Advisors

Colin Blaney is a Senior Partner at HealthScape Advisors, a Chartis Company with more than 20 years of healthcare and management consulting experience. He has extensive experience working with executives and leading teams at healthcare organizations to define and execute strategies that improve the member experience, increase the quality of care, and optimize the costs associated with delivering and administering healthcare services.

Pravith Nambiar

Senior Partner, HealthScape Advisors

Pravith Nambiar is a Senior Partner at HealthScape Advisors, a Chartis Company with more than 15 years of payer advisory experience. He has led large-scale, enterprise, and multi-year roadmap initiatives and provided expert approaches to complex healthcare problems with a deep focus on key business drivers and stakeholder needs.

Bethany Richmond

Senior Partner, HealthScape Advisors

Bethany Richmond is a Senior Partner at HealthScape Advisors, a Chartis Company with 20 years of experience in the healthcare industry. She has extensive advisory experience, serving healthcare clients across the provider-payer spectrum.