For years, the healthcare industry has wrestled with the same problems: inefficient claims review processes, audits that frustrate providers, and billions of dollars wasted on inaccurate payments. Until now, the fix for payment integrity has been reactive, manual, and stuck in the past.
But it’s 2025, so it’s time we modernized things a bit. By adding AI into the mix, payment integrity is getting a much needed makeover. Here’s what you need to know.
AI is the Tool, Precision is the Goal
Forget chasing claims after the money’s already out the door. Today, leading payers are using AI not just to analyze payments, but to anticipate adjustments before they need to be made.
This isn’t just automation for automation’s sake. This is intelligent infrastructure that is engineered to identify patterns in massive datasets, flag inaccuracies, and learn over time. The result? Less waste, fewer abrasive audits, and a system that finally works the way it should. The market share for AI in healthcare is expected to grow 524% by 2030. Payment integrity leaders need to see AI as the path forward. It’s not a buzzword, not a side project, it’s a core function of how health payers can and will operate.
In-House or Outsource? The Smartest Teams Do Both
It’s not about choosing one or the other. It’s about designing a model that combines internal expertise with best-in-class external solutions. That’s what 80% of health plans are doing—leveraging third-party innovation while staying strategically in control. It’s a hybrid model built for agility and impact.
Payment integrity isn’t just about plugging holes anymore. (Tech debt, anyone?) It’s about building systems that get smarter, faster, and more efficient over time. Systems that make healthcare less expensive and more efficient for everyone.
The first step to building that system? Moving the payment process upstream—“shifting left”—to catch errors before the claim is paid.
From Recovery to Prevention: The Shift That Changes Everything
Recovery-based payment integrity has been the industry’s fallback for decades. We call this post-pay recovery, and it goes like this: a provider submits a claim for reimbursement, the payer pays, bill reviews reveal mistakes, and the payer audits the provider and tries to collect back money that was already paid out. Suddenly, but unsurprisingly, no one is happy. By the time a mistake is caught, it’s already a friction point with providers, members, and the payers’ own teams.
The shift to pre-payment solutions is faster, cleaner, and more respectful of everyone’s time. In fact, it makes so much sense that 72% of payers are moving upstream, investing in tech that catches errors before they impact the payment cycle. This is where everything changes. When providers can bill accurately the first time and payers can pay confidently, everyone wins.
Why Machinify?
Bear with us, we’re going to talk about ourselves for a minute.
We’re not just another vendor. With over 40 years of experience, we understand how complex claims work and how to fix them. We brought together four industry leaders, creating cutting-edge AI technology to solve the biggest problems in payment integrity once and for all.
Machinify’s platform uses advanced AI and clinical insights to bring order to your most chaotic payment workflows. We help you to prevent errors before claims are paid, saving your team time and money.
You’ve tried bolt-on tools and you’ve seen diminishing returns from traditional approaches. Been there, done that. What you need now is a smarter way to do payment integrity from the ground up. The best part? It doesn’t need to be difficult. We’re the partner that protects your bottom line without adding complexity.
This is the year payment integrity evolves from a cost center to a strategic advantage. Let’s build the system your organization deserves. To learn more about how Machinify can make your payment integrity program smarter, contact us.
