Case Study: a top national healthcare payer improves payment integrity with EXL Health

A collaborative partnership leads to an ever-evolving payment integrity program

EXL worked with a top national healthcare payer that needed to modernize its payment integrity program. The payer had ambitious savings goals but was constrained by legacy processes, a traditional vendor ecosystem, and an internal team that was not delivering industry-leading results, while also needing better analytics, forecasting, reporting, and lower provider abrasion.

EXL Health implemented a custom payment integrity solution using advanced analytics, AI, machine learning, and subject matter expertise to identify overlooked audit opportunities, improve processes, and review claims earlier in the payment lifecycle. The revamped program uncovered significant savings, including a 33% findings rate on claims previously reviewed by another vendor, while also improving efficiency, reducing touch points, and creating a more agile and consultative payment integrity operation.