Improper payments across U.S. healthcare programs exceed $100B annually, underscoring the need for earlier, data driven intervention.
Provider coding intensity has increased significantly over time, contributing to higher improper payments and increased downstream PI burden.
A large portion of provider AI investment is focused on coding and billing automation, accelerating how coding patterns and behaviors evolve.
Payment Integrity teams are expected to catch more issues earlier, recover faster, and scale with fewer resources—but today’s tools make that nearly impossible. The result: PI teams stay reactive, spend more on contingency fees, and struggle to shift left.
Whether you’re supplementing existing vendors, shifting more PI in house, or preparing for AI enabled analytics and workflows, Abacus provides the data foundation to help you act earlier, move faster, and scale with confidence.
Frequently Asked Questions
What is Payment Integrity and why does data matter so much?
Payment Integrity helps health plans prevent, detect, and recover improper payments across pre‑pay and post‑pay workflows. Abacus focuses on fixing the underlying data problem, giving PI teams a unified, governed view instead of relying on fragmented, claims‑only inputs.
How can payers shift left in Payment Integrity and do we need to replace our current vendors?
Shifting left requires earlier, richer context. Abacus sits in front of existing PI vendors, unifying claims, clinical, and provider data so payers can intervene earlier while continuing to leverage their current ecosystem.
Why do Payment Integrity programs struggle with transparency today?
Many PI programs rely on vendor‑owned logic and siloed outputs, creating black‑box decisions and mis-aligned incentives. Abacus restores visibility and control by making PI data usable and shared across vendors and internal teams from a single foundation
How does Abacus enable AI in Payment Integrity—without adding risk?
Abacus prepares PI data to be AI‑ready first, so analytics and GenAI can be applied safely and incrementally. This allows payers to adopt AI when and where it makes sense, without disrupting workflows or amplifying bad data.
Enables compliance with the Centers for Medicare and Medicaid Services’ requirements for interoperability for patient access
Unifies and delivers timely data for effective risk adjustment of government-sponsored plans to optimize care for high-needs members
Integrates clinical, administrative, and health equity data into longitudinal member and patient records to provide a holistic view of the care journey
Supports performance measurement and scaling of complex value-based and fee-for-service arrangements by providing current, complete, and accurate data
Delivers insights-ready™ data for accelerating the best interventions for improving quality, outcomes and Star Ratings
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