At AMPS, we’re not just delivering technology, we’re helping lead a movement toward smarter, more transparent, and clinically validated payment integrity. That’s why we were proud to be featured on Millennium Live, the podcast series hosted by the Millennium Alliance. In this episode, titled “Breaking the Black Box: Solving Payers’ Biggest Payment Integrity Challenges,” our very own Matt Akromis, Vice President of Sales & Client Success of ClaimInsight, sat down with podcast host Conor Tuohy to unpack some of the most urgent and complex issues facing health plans today.
The conversation zeroed in on a rising concern: traditional payment integrity systems are no longer equipped to handle the complexity and pace of today’s healthcare claims. Matt opened the episode by highlighting how U.S. medical spend has surged by 25% since 2020, rapidly pushing healthcare expenditures toward the $5 trillion mark. Health plans are under increasing pressure to not only control costs but to do so in a way that’s both clinically sound and operationally efficient. This requires moving away from outdated, opaque solutions that often act after the damage is done and toward proactive, data-driven strategies that stop overpayment before the check is cut.
One of the biggest challenges discussed was the continued reliance on legacy adjudication engines and “black box” payment integrity vendors. These systems are typically rigid, reactive, and far too generalized. They frequently miss opportunities to catch critical overpayments, especially in high-dollar inpatient claims, where clinical context is essential. Matt explained how ClaimInsight, AMPS’ flagship solution takes a fundamentally different approach. Rather than operating in the dark, ClaimInsight delivers full transparency, enabling clients to understand exactly why a claim is being flagged and what clinical rationale supports it.
What truly differentiates ClaimInsight is the integration of technology with physician-led clinical expertise. While many vendors rely solely on coders or software rules, AMPS brings in practicing physicians to review and validate complex claims. This hybrid model combines speed with clinical accuracy, catching errors and unnecessary charges that would otherwise slip through. The solution is also flexible: while many vendors set high thresholds (often $150K+) for claim reviews, ClaimInsight offers configurable thresholds starting as low as $25K, ensuring more opportunities for savings across the board.
The results speak for themselves. On average, ClaimInsight helps health plans save:
These savings are on top of what legacy vendors have already attempted, proving that there’s still significant leakage in the system that only ClaimInsight is equipped to catch.
As the conversation wrapped, Matt emphasized the importance of continuous optimization and proactive strategy in payment integrity. What worked yesterday won’t be enough tomorrow. Health plans need transparent, clinically robust partners who don’t just find errors, they help prevent them in the first place.
If you're a health plan, TPA, or broker tired of black box vendors and unpredictable results, this podcast episode is a must-watch.
Click here to watch the full episode now.
