“With about seven percent of all public and private health insurance claims paid incorrectly, insurers have a ways to go, beyond traditional models, if the healthcare spending crisis is to be reined in.

Private insurers historically were apt to raise premiums to cover rising healthcare inflation and, like Medicare, to “pay and chase” incorrect claims. But that may not be sustainable for much longer.

With provider upcoding and demand for healthcare services bound to continue … payment integrity is one area where insurers can start to make a large difference.”  Read more here.