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Your health plan is committed to paying claims quickly and correctly, but you can’t avoid the millions of dollars that slip through the cracks—cracks caused by older claims technology, ever-changing CMS rules and regulations, and a multitude of contractual terms.
Our comprehensive Data Mining solution not only helps identify and recover improper claims payments associated with adjudication errors, billing errors, or contract language but also works to fix the leaks, preventing the reoccurrence of these errors in the future. Our Data Mining service is available for many health plan offerings, including at-risk commercial, Medicare Advantage, Medicaid Managed Care, state Medicaid plans, and third-party administrators.
Administrative complexity continues to drive the high level of waste in healthcare. Learn how to reduce improper payments with an optimized payment integrity approach that blends advanced analytics with human expertise.
From implementation through delivery and reporting, we put health plans first in everything we do to ensure our Data Mining solution is fully aligned with your plan.
We customize our Data Mining services to support your plan’s unique policies, combining industry-standard and client-specific elements to facilitate a smoother review process.
Gain critical business intelligence to better identify overpayments and root causes across multiple years and categories.
Our flexible, sophisticated analytics and logic, blended with human intelligence, help catch and prevent overpayments according to your specific business processes.
Recover and restore value to get the revenue you deserve and make healthcare more affordable.