• Developing a roadmap for effective clinical data integration into pre-pay PI decision making and workflows
• Reimagining the PI process – new capabilities, collaboration, and upscaling staff
• Lessons learned while shifting from traditional post-pay operations and governance

Payment integrity is evolving from a downstream claims audit function to a proactive, critical lever for upstream cost avoidance. Payment integrity leaders note that ‘shifting left’ can cut administrative duties by at least 10-15%, in addition to improving provider abrasion. But evolving to cost avoidance not only requires a shift in mindset, but an evolution in how data, AI tools, and cross-functional collaboration are used to enable proactive decision making.

• Case studies: Critical strategies for launching pre-pay programs and measuring ROI
• How AI is expanding pre-pay capabilities and required governance
• Rethinking the impact and attribution of provider education initiatives

In partnership with Optum

The payment integrity vendor landscape has expanded rapidly, with plans now juggling specialist partners across pre-pay, post-pay, DRG validation, COB, FWA, clinical review, and an ever-growing list of AI-enabled point solutions. While each vendor promises incremental savings, the cumulative cost of sourcing, contracting, onboarding, integrating, and reconciling reporting across a sprawling stack is becoming a payment integrity problem in its own right. This panel brings together PI leaders who have wrestled with rationalising their vendor ecosystems to share practical approaches for building a leaner, better-orchestrated, and easier-to-manage vendor stack without losing savings yield.

• How to evaluate and source new vendors efficiently, including which proof points and pilot structures actually predict in-production performance
• Designing a waterfall and integration model that minimises duplicate findings, claim leakage, and operational drag across multiple vendors
• Consolidating vendor reporting and KPIs into a single view so PI leaders can defend total program value to senior leadership

Code updates. Site-of-service rule changes. Specialty drug billing classifications. Telehealth policy still being written. Coding technology evolving. The environment that edit programs have to keep up with in 2026 is more complex than it has ever been, and an annual review cycle is not enough. This session looks at what a well-governed, modern, continuously maintained edit program looks like in practice, where the most costly gaps tend to open and how technology can keep your plan ahead. 

• How to build an edit governance process that keeps pace with frequent policy changes across multiple lines of business
• Where the highest-risk edit gaps are opening right now and how to prioritise closing them without expanding every programme at once
• How to defend edits in provider disputes when the underlying policy they are based on is itself in transition

In partnership with Shift Technology

State program integrity teams, MCO SIUs, and partners are moving beyond static reporting toward real-time collaboration models that improve visibility and coordination. This panel explores how shared data and centralized platforms are enabling earlier detection, stronger oversight, and more aligned decision-making across the ecosystem.

• How a centralized portal enables real-time information exchange between OIGs, MCOs, SIUs, and partners
• The impact of shared intelligence on identifying high-risk providers and managing overpayments
• How improved collaboration is influencing actuarial processes and managed care rate setting

In partnership with HMS, Gainwell

Key discussion points:
- How state agencies and managed care organisations can build collaborative infrastructure to facilitate information exchange among MCO SIUs, oversight bodies, actuaries, and auditors
- Impact of shared information exchange on anomaly detection, high risk providers, and overpayment management
- How improved collaboration impacted managed care rate setting

Key discussion points:
- How state agencies and managed care organisations can build collaborative infrastructure to facilitate information exchange among MCO SIUs, oversight bodies, actuaries, and auditors
- Impact of shared information exchange on anomaly detection, high risk providers, and overpayment management
- How improved collaboration impacted managed care rate setting