Health Systems Tackle Payer Compliance Issues

Numerous issues continue to impact systems’ payment and accounts receivables. Among the top ones according to the recent Vizient® Payer Strategies Network Survey: clinical and technical denials, DRG downgrades and claim delays.

Source: Vizient Member Networks, Payer Strategies Network, 2025.

In response, health system finance teams are deploying myriad tactics to address payer compliance issues. They’re having mixed success.

Some organizations are exploring AI-driven solutions to automate appeal letters and Epic-based payer scorecards to identify compliance patterns. The approaches have helped improve contract language compliance and strengthen denials appeals. Though not yet widely adopted, these efforts continue to ramp up.

High litigation costs limit systems’ ability to pursue legal action to address non-compliance. There are a limited number of legal firms that specialize in contingency-based cases for payer disputes. But organizations also report moderate success improving contract terms by leveraging formal dispute proceedings, mediation and arbitration.

The Vizient® Payer Strategies network includes leaders from across the country specializing in the managed care space at their organizations.

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