Claritev shifts payment integrity strategy toward pre-pay overpayment prevention to boost ROI
CTEV•Claritev outlines shift toward pre-payment prevention
- Claritev outlined a shift in payment integrity toward pre-payment prevention, aiming to reduce improper payments before claims are adjudicated.
- Future program focus includes expanding and refining edits, using predictive scoring to target higher-risk claims, and improving anomaly detection.
- Planning priorities include limiting provider abrasion, managing false positives, and protecting claim cycle times to avoid prompt-pay compliance pressure.
- The strategy calls for a balanced model, pairing stronger pre-pay controls with targeted post-payment recovery to address residual risk.
- August 18, 2026 commentary flagged prevention as a higher-ROI approach than recovery due to lower downstream administrative burden.
