Becker’s Payer Issues Podcast Moving Payment Integrity Upstream with Jhana Spence of CERIS
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Mar 31, 2026 Jhana Spence, Senior Vice President of Strategy at CERIS, brings deep payment integrity and claims strategy experience. She talks about shifting payment accuracy earlier in the claims lifecycle. Short takes cover why moving left matters now. She highlights prepay workflows, where analytics and automation add value, and the future of proactive, collaborative payment integrity.
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Moving Left Builds Accuracy Before Payment
- Moving left means shifting payment integrity activities earlier in the claim lifecycle, closer to submission, adjudication, or authorization.
- This embeds accuracy via better data, analytics, and workflows so errors are prevented rather than corrected later.
Prioritize Upstream PI Because The Environment Demands It
- Do prioritize upstream PI because financial pressure, provider tolerance, and technology maturity make post-pay insufficient.
- Jhana cites thin plan margins, provider pushback on retrospective audits, and improved tech as practical drivers.
Post Pay As A Backstop Not A Foundation
- Post-pay audits still add value but act best as a backstop rather than the primary PI strategy.
- Retrospective audits create recoverability issues, lengthy appeals, and strained provider relationships that reduce net recovery.