Getting Healthcare Claims Paid Right, With Less Waste

A source of inefficiency in U.S. healthcare is the process for detecting and correcting inaccurate insurance claims payments. Traditional approaches, based on claims auditing, use a “pay and chase” process to recover improper payments. On today’s program, Change Healthcare’s Phillip Cardona and Mike Spellman discuss alternatives to pay-and-chase, including an innovative approach that helps payers and providers work together to catch errors early, reduce administrative overhead, and improve payment accuracy.

Phillip Cardona is strategy executive for Change Healthcare’s Payer Growth Program. Mike Spellman is a senior director for Payment Accuracy Solutions at Change Healthcare.

Phil and Mike discuss:

  1. Contrasting traditional payment integrity and proactive payment accuracy programs
  2. How primary and pre-submission claims editing work with retrospective payment integrity reviews
  3. Efficiencies gained from identifying claims coding and payment errors earlier
  4. Why provider collaboration and transparency is essential
  5. The phases of payment accuracy maturity
  6. The role of technology in improving payment accuracy
  7. Leadership challenges for payers and providers

Episode Resources

  1. Phillip Cardona’s bio
  2. Mike Spellman’s bio
  3. Change Healthcare Payer Growth Program
  4. Change Healthcare Industry Insights
  5. COVID-19 Updates and Resources
  6. COVID-19 Updates Newsletter
  7. Change Healthcare Insights Newsletter

Show Resources