Payor Integrity

Managed care payor integrity encompasses the processes and activities that oversee contracts between the UTMB health system, its provider network, and payors (including insurance companies, HMOs, and government programs like Medicare and Medicaid). These contracts define the terms for reimbursement of services provided to insured patients. Payor integrity ensures that claims are paid accurately, contract terms are honored, and both overpayments and underpayments are identified and corrected.