Payment and Revenue Integrity Services

A connected approach that creates profound results for healthcare payors

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Prevent. Correct. Recover.

The ability to pay claims quickly and accurately is critical to healthcare payors’ overall success, yet as many as a third of claims industry-wide are paid incorrectly each year, contributing to more than $1 trillion in annual waste. Multiple and aging technologies, ever-changing regulations and member churn all impact healthcare payors’ ability to catch errors within the total lifecycle of a healthcare claim, leading to incorrectly paid claims, improper reimbursements or claims that shouldn’t be paid all. As a result, payors must work harder to increase payment accuracy, reduce waste, and drive revenue growth while maintaining a competitive edge. Even more challenging is finding the time and resources to efficiently correct and recover claims.

Connect solutions to the entire claims lifecycle

Connect a full suite of payment integrity solutions to your organization’s entire claims lifecycle—solutions that analyze and impact the right eligibility and claims at the right time so they are paid correctly the first time. Our payment and revenue integrity services are connected to one another, efficiently sharing data and insights and moving the impact upstream whenever possible.

Connect to your organization’s payment integrity challenges

Connect to your organization’s payment integrity challenges, data, claims adjudication process, complex state and federal rules, provider billing patterns and areas that are ripe for overpayments to capture savings.

Connect to our team

Connect to our team so we can act as an extension of yours and as a partner in solving the root causes of your payment integrity challenges.

Our Connected Payment Integrity approach

Our services don’t just span the claim lifecycle, they connect to each other to convert recoveries into future correction and prevention opportunities. And they connect to our customers as a true complement to their existing processes.

Explore our services

Pre-Payment Clinical Review

Correct billing errors before payment and eliminate wasteful claims spending.

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Itemized Bill Review

Compare facility charges billed with your payer guidelines and national coding and billing standards to identify and correct inappropriate charges before they’re paid.

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Coordination of Benefits

Identify instances of other health insurance coverage to maximize recoveries and drive future cost avoidance.

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Subrogation

Maximize recoveries from other responsible parties with improved identification and correction to prevent future overpayments.

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Data Mining

Dig deeper into claims data to identify and resolve incorrectly paid claims, as well as address root-cause issues for future error prevention.

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Revenue Integrity

Find and restore premium dollars owed to you for managing Medicare Advantage members.

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Our Payment and Revenue Integrity key benefits

Your Payment Integrity partner,
not a vendor

Relentless focus on the client

From implementation through delivery, our priority is to ensure our payment integrity program is meeting and exceeding our clients’ expectations.

Flexibility

Unlike vendors who offer a standard one-size-fits-all solution, our flexible approach allows us to partner with our clients to create value-added payment integrity services specifically designed to achieve their goals.

Best-in-class account management support

We assign a dedicated, experienced team to expertly manage our clients’ programs from the earliest stages of implementation through ongoing program delivery.

Experience

Most vendors have a post-pay-only heritage; our long-tenured focus on the entire claims lifecycle is backed by over three decades of pre- and post-pay experience.

A Payment Integrity partner you can count on

– COB Team Leader, regional healthcare plan

– Manager, large Midwest health plan

– Payment Integrity and Performance Manager, national health plan

Payment and Revenue Integrity Services

Prevent. Correct. Recover.

Our Connected Payment Integrity approach