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Everyone involved in health care delivery wants accurate billing and payment. Our team partners with providers, payers and other stakeholders to improve accuracy and transparency. 

Our payment integrity solutions can be implemented at any stage. And they integrate with your existing processes.

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  • 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

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Explore our solutions

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Comprehensive payment integrity

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A comprehensive strategy improves savings and relationships and reduces administrative costs. Our experience, data and analytics help health plans develop strategic roadmaps. This helps you identify immediate and long-term opportunities to improve performance.

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Realize cost savings with our payment integrity solutions. 

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