The Role of Payment Integrity in Health Care

The Payment integrity Department is responsible for ensuring that a claim for service is paid correctly. We verify that that the claim is properly coded, and the claim is in compliance with the diagnosis and various statutory and regulatory requirements. The Payment Integrity Department also provides oversight of the Special Investigation Unit (SIU).

In addition, the Payment Integrity team manages the subrogation process. Subrogation is a legal term that describes a right held by most insurance companies to legally pursue a third party that caused an insurance loss to the insured. When an insurer compensates its insured for a covered claim, subrogation authorizes an insurance company to seek reimbursement from the liable party. Some examples of subrogation claims are car accidents, slip and falls, medical malpractice, etc.