The healthcare claims process is notoriously complex and often creates friction between payers and providers. This article examines the disconnect between Prior Authorization (PA) and Payment Integrity (PI), highlighting how their separation leads to inefficiencies, payment delays, and eroded trust. Traditionally, PI functions as a post-claim corrective measure, identifying errors after services are rendered.
The proposed solution is a ‘First Time Right’ approach, integrating PI rules into PA workflows to deliver upfront transparency and accuracy. This proactive model fosters trust, prevents errors, and ensures predictable reimbursement.

Real-time validation and immediate feedback during PA submission can significantly reduce administrative burden and appeals. Though this shift requires investment and operational change, it promises substantial benefits: streamlined processes, improved collaboration, and enhanced financial performance.

Read the article featuring Mitesh Kumar, Senior Vice President, Senior Vice President of the Claims Practice at Sagility, at Healthcare News Today, Bridging the Gap Between Prior Authorization and Payment Integrity or at Insights > Blog