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Payment Integrity

Maximize savings, minimize errors with AI agent-driven payment accuracy for health plans

AI Agent-powered edits, optimized scenarios, accelerated workflows. Take control of your payment integrity at critical steps of the healthcare claims process.

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Catch issues before they cost you

Shift payment integrity delivers AI-driven accuracy at key points in the claims process—analyzing policy, provider behavior, and records to prevent costly errors and identify emerging schemes. Shift empowers health plans to act quickly and precisely, boosting prepay savings and postpay recoveries.

Claims editing
Claims editing Accelerated medical record review Data mining FWA detection
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Claims editing
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Accelerated medical record review
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Data mining
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FWA detection
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Go beyond generic or outdated edits that leave savings opportunities on the table with a tailored approach and trusted AI that helps plans prevent more loss

Up-to-date content

Keep a pulse on policy and plan guidelines with automatic updates of code sets and industry releases.

Any-pass deployment

Policy-driven edits

Powerful detection across the Payment Integrity lifecycle

Pre Payment
Pre Payment Post Payment
Pre Payment
Post Payment
Shift’s payment integrity solution enables lightning-fast detection and decisioning before a claim is paid. Shift's AI agent-powered claims editing and prepay FWA detection stops improper payments and emerging schemes in their tracks. Combined with enhanced external data, teams are equipped with the context behind the decision or alert to quickly conduct investigations and reduce provider abrasion.

Accelerating Payment Integrity with Agentic AI

As the care delivery, policy and payment landscape evolves, payment integrity innovation must keep up. Learn how modern tools such as agentic AI can help teams take on the challenges in the wake of policy or care delivery changes, medical record and other document review, and reducing provider abrasion with fast, accurate analysis of claims.

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Learn how Shift agents can help you strengthen your plan’s payment integrity.

 

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