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The payment integrity (PI) industry plays a critical role in US healthcare, ensuring that claims adjudication is accurate and that physicians and health systems are reimbursed correctly for care delivery. We estimate the $9 billion industry has grown at a 7 percent CAGR in recent years, reflecting growth in US healthcare spending and persistent complexity in billing processes.
This growth has coincided with technological change, such as the rise of generative AI (gen AI), and payment model innovation, including the transition of about 60 percent of total care delivery reimbursement to value-based care (VBC) payments1—shifts that have the potential to transform the PI industry. This article discusses these trends and the implications for payers, care delivery organizations, PI companies, and investors.