The February 2023 Aite-Novarica Group report, based on a survey of 214 healthcare payer executives, examines payment integrity and cost containment, outlining the next phase of payer-provider collaboration. The shift toward pre-pay automation aims to prevent overpayments, though manual processes persist, especially in Medicare and Medicaid claims. Complex DRG reviews remain a challenge, with less than half of payers adopting them. Communication gaps with providers contribute to denials and appeals, as only two-thirds maintain regular contact. Fully automated adjudication averages 27%, highlighting the long path to end-to-end automation in claims processing.

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