New benchmarking data from ClarisHealth, provider of Pareo the only payment integrity platform that closes the loop across the audit lifecycle, highlights how a focused set of payment integrity concepts drives disproportionate value across health plans.
NASHVILLE, Tenn., April 15, 2026 /PRNewswire-PRWeb/ -- Today, ClarisHealth announced the release of its second annual Payment Integrity Benchmarking Report during a keynote presentation at the Power of Payment Integrity Conference, the industry's only peer-led event dedicated to advancing payment integrity strategy.
Building on insights from the inaugural 2025 report, this year's benchmarking analysis introduces a new lens on payment integrity program performance: concept-level governance.
The report highlights key metrics including:
- Of the $17.8 billion total savings managed through the company's Pareo® platform across all clients in 2025, $8.3 billion were driven by concept-based initiatives.
- More than 1,000 unique payment integrity concepts were identified across participating programs, spanning 27 distinct concept categories.
- The top five concept categories alone accounted for $6.7 billion in savings—representing 37% of total savings analyzed.
Together, these findings demonstrate that a relatively small subset of well-defined concepts can drive a disproportionate share of payment integrity value, according to lead researcher Tom Baggett, senior director of operations and client success at ClarisHealth.
"The scariest thing in payment integrity isn't what you know you're missing—it's what you don't know you don't know," said Tom Baggett. "This benchmarking effort is about shining a light on that. When you start measuring at the concept level, you uncover a completely different view of your program."
The industry experts at ClarisHealth, provider of Pareo the only payment integrity platform that closes the loop across the audit lifecycle, validated the benchmarks based on proprietary data and research gathered from de-identified data from more than 20 health plans. The 2026 report builds on the original body of research, demonstrating how leading health plans are beginning to manage performance at a more granular, actionable level.
"Most health plans manage payment integrity at the savings level. Leading plans are starting to manage it at the concept level," Baggett added. "Benchmarking is how you get there. And when you start, you're going to see things you've never seen before about your program—that's the point. A better set of problems means you now know what to go fix."
The findings reveal a consistent pattern across participating organizations: a relatively small number of concepts often drive a disproportionate share of total savings. This insight reinforces the value of structured concept identification and governance as a foundation for more mature, scalable payment integrity programs.
"This is the kind of data our market has needed," said Sara Thomas, vice president of payer strategy for ClarisHealth, who co-led the research. "For the first time, health plans can see how their concept performance actually stacks up—and use that to drive real program strategy."
As administrative costs rise and pressure mounts to deliver more efficient, transparent outcomes, the report positions concept-level governance as a critical next step for the industry.
"Concept-level governance is where the market is heading," Thomas added. "Health plans that make this shift now will be managing a fundamentally more mature payment integrity program—and that's a competitive advantage."
The Power of Payment Integrity Conference convenes leaders from health plans across the country to share best practices, explore new approaches, and collaborate on advancing the industry. This year's benchmarking report underscores a broader industry movement toward standardization, transparency, and more strategic use of data.
ClarisHealth plans to continue expanding the benchmarking initiative in future years, with the goal of establishing a consistent, industry-wide framework for measuring and improving payment integrity performance.
About ClarisHealth
ClarisHealth, a six-time Inc. 5000 company, three-time Deloitte Tech 500 company, and recognized in the Gartner Hype Cycle for U.S. Payers and Everest Group's Payment Integrity Solutions PEAK Matrix® Assessment, provides health plans and payers with a better way to drive claims payment accuracy. Its proprietary, A.I.-powered enterprise technology platform Pareo® has been proven to help health plans streamline payment integrity operations, expand recoveries and reduce administrative costs for an industry-leading ROI. For more information please visit www.clarishealth.com. For more information on the company's Power of Payment Integrity Conference, please visit www.clarishealth.com/events/pop-conference/.
Media Contact
Amanda Bair, ClarisHealth, 1 8554252747, [email protected], www.clarishealth.com
SOURCE ClarisHealth
Share this article