Payment Integrity Solutions

Accurate, effortless payments at all touchpoints in the claim lifecycle

Prevent, Edit, Price, Assess, Recover, Advise

The Claim Lifecycle

Create, submit, process, adjudicate, pay, 

Prevent: 

Prevent inaccurate billing. Solutions designed for accuracy before bills reach payers EDI messaging.

Provider Education

Edit:

Edit inaccurate bills. Solutions designed to enable edits as appropriate during pre-adjudication, mid-adjudication, pre-payment, or post-adjudication.

Claims Edit System
EDC Analyzer

Price:

Price bills appropriately. Solutions designed for accuracy pre-payment.

Prospective Payment System
Network Solution

Assess:

Assess bill details. Accuracy assessed across pre-adjudication, pre-payment, and post-payment processes .

Itemized Bill Review
Subrogation
Claims Validation
Coordination of Benefits
Data Mining

Recover:

Recover overpayments. Solutions designed to increase recovery rates with minimal abrasion and transparency.

Credit Balance
Payment Recovery

Advise:

Advise on the full payment integrity landscape. A comprehensive design to reduce administrative cost and enhance accuracy across the lifecycle of a claim.

Advisory Services