As medical spending continues to rise, payment integrity is becoming a more strategic lever for health plan performance. In this interview, Mark Noel, General Manager and Senior Vice President of ClaimInsight at AMPS, explores how the market is shifting and why health plans are demanding a more transparent, accountable approach to claims accuracy and vendor partnerships.
Noel explains how the conversation has moved beyond identifying overpayments to building systems that deliver continuous visibility, stronger financial accountability and greater control over policy logic. As health plans become more sophisticated buyers, they are looking for payment integrity models that evolve in real time and align more closely with long-term enterprise goals.
The discussion also examines why high-dollar inpatient claims remain a critical pressure point and how physician-led reviews, paired with detailed bill analysis, can help plans act earlier in the payment lifecycle. The result is not only stronger savings retention, but a more durable strategy for reducing appeal risk and improving confidence in payment decisions.
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