SPOTLIGHT Sponsored by: HealthEdge Prospective Payment Integrity: Moving from "Pay and Chase" to Predictive November 2022 Written by: Jeff Rivkin, Research Director, Payer IT Strategies Introduction Modernization/digital transformation (DX) is increasingly occurring with payer operational systems in areas such as claims editing services and fraud, waste, and abuse (FWA) analytics to ensure accurate claim payments. Consumers, employers, and providers are demanding accurate claim payment in this new era of member and provider "relationship management" for payers. The spectrum of payment integrity is broad, as depicted in Figure 1. FIGURE 1: Payer Payment Integrity Source: IDC, 2022 Predictive, Preemptive, Prospective Claims Accuracy/ Editing Clinical Validation Co

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