Payment and Revenue Integrity Services
A connected approach that creates profound results for healthcare payors
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.
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
Post-Payment Clinical Audits
Coordination of Benefits
Our Payment and Revenue Integrity key benefits
Connected Payment Integrity services
address the entire claims lifecycle to analyze the right eligibility and claims at the right time so they are paid correctly the first time
Combined machine + human intelligence
offer the best of both technology and human power to help clients achieve payment integrity success
A nimble, flexible process
ensures we meet the unique needs of each client
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.
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.
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.