The Payment Integrity Transparency Guide

Payment integrity programs are generating more savings than ever–but for many health plans, the story behind those savings remains unclear. When findings can't be explained, root causes can't be traced, and reporting varies across vendors and workflows, the result is legacy vendor dependency, recurring overpayments, and savings figures you can't fully stand behind.

As PI operations grow more AI-enabled and complex, transparency isn't just a nice-to-have. It's the foundation of a program that's controllable, scalable, and built to last.

This guide introduces a framework for evaluating transparency across different PI vendor models–and the questions every health plan should be asking before signing or renewing a vendor contract.

Download the guide to learn:

• The three dimensions of PI transparency: Explore the Detection–Action–Performance framework and what true transparency looks like at each stage of the PI lifecycle.
• How vendor models compare: Understand how varying vendor models approach transparency across detection, action, and performance.
• What questions to ask: Get a practical list of questions to uncover how findings are generated, how savings are calculated, and whether your team can operate and optimize independently.

The right PI program doesn't just recover dollars–it gives you the visibility to prevent overpayments, validate outcomes, and continuously improve. Learn what transparent payment integrity looks like and how to evaluate whether your current vendor delivers it.