Relentless Health Value EP498: The Payment Integrity Arms Race—RCM (Revenue Cycle Management) and Plan Sponsors, With Mark Noel
Jan 29, 2026
Mark Noel, a payment integrity and RCM executive with 25 years in prepayment integrity, explains the ongoing arms race between revenue cycle management and plan sponsors. He highlights small-dollar claim waste, the need for prepayment edits integrated with TPAs, conflicts of interest in auditing, and technical clearinghouse challenges. Short, urgent, and focused on protecting plan dollars.
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Small Claims Create Big Losses
- About 80% of claim volume is small professional claims while large claims consume more spend.
- Small-dollar errors aggregate into millions, making them a major source of waste.
Prioritize Prepayment Editing For Small Claims
- Catching small-dollar errors requires prepayment editing because retrospective recovery isn't worth the logistics.
- Implement automated prepay checks to stop thousands of $5–$10 overpayments from accumulating.
Vaccine Double-Billing Example
- Vaccination billing often shows duplicate charges for the vaccine and its administration despite edits prohibiting both.
- Mark Noel uses this common $5 error to show how tiny mistakes multiply across volume.