The payment integrity market is dynamically transforming, continuously adapting and enhancing fundamental capabilities within the healthcare industry. The growing emphasis on ensuring accurate and efficient payment processes is creating various opportunities. Key trends gaining prominence include advances in fraud detection and prevention technologies, using sophisticated data analytics for claims validation, integrating AI to identify irregularities, and implementing predictive modeling to forecast potential risks. The industry is experiencing a surge in collaborations and partnerships among payment integrity solution providers, healthcare organizations, and regulatory bodies to create robust ecosystems that foster innovation. Additionally, there is a notable shift toward leveraging next-generation technologies, such as generative AI, to enhance payment accuracy. This evolution underscores the industry’s commitment to refining payment integrity practices through technology innovation and strategic collaborations.

In this report, we analyze 18 payment integrity solutions providers featured on the Payment Integrity Solutions PEAK Matrix^®. The report positions providers’ market shares relative to each other and evaluates their strengths and limitations. The study will enable healthcare payers to identify suitable providers to transform their business processes and differentiate themselves.

Scope

• Industry: healthcare
• Geography: global
• The assessment is based on Everest Group’s annual RFI process for the calendar year 2023, interactions with leading payment integrity solutions providers, client references, and Everest Group’s ongoing analysis of the payment integrity solutions market

Contents

This report analyzes 18 payment integrity solutions providers and includes:

• Providers’ relative positioning on Everest Group’s PEAK Matrix^® for Payment Integrity Solutions
• Providers’ capabilities and market shares
• Key strengths and limitations

Membership(s)

Healthcare Payer and Provider Business Process

Sourcing and Vendor Management