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Get Payment Integrity Right the First Time eBook

Rising U.S. healthcare costs are reaching crisis levels. The United States spends more on healthcare per capita than any other country, and total spend as a percentage of gross domestic product (GDP) is increasing annually. In 2018, healthcare costs comprised 17.7% of total GDP. By 2028, this is expected to increase to nearly 20%, totaling $6.19 trillion.1

This playbook covers:

  • The complexities of claims cost management for payers and the inefficiencies of post-payment claims administration.
  • How managing multiple systems, technologies, and vendors can lead to waste.
  • An example of how Zenith American Solutions improved claims management efficiency and effectiveness after implementing a comprehensive pre-payment solution.
  • The importance of choosing a technology architecture that ensures accurate and prompt payment, either through a complete integration of claim services or a best-of-breed pre-payment solution.
  • Why flexibility and technology customization are critical in a complex claims environment where one size doesn’t fit all payers.

1 Tikkanen, R., Melinda K. Abrams, M.K. U.S. Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes? Commonwealth Health Fund. https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019

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