Pioneering the Future
of Payment Integrity
Where healthcare expertise meets innovative technology to transform payment integrity
About Us
Extensive experience in the health insurance industry with a specialization in Payment Integrity Solutions
We have extensive experience in the health insurance industry with a specialization in Payment Integrity Solutions. Our experience includes post and pre-pay savings as well as revenue maximization for Commercial, ACA, Medicare Advantage and Medicaid clients.
- Quality Improvement
- Call Center and Dispute Support
- Less than 5% overturn rate
- Post-pay Recovery migration to Pre-pay Avoidance
Client and Results
Baseline for Health Plans
Mature Payment Integrity Departments should experience the following as a percentage of medical expense savings:
Medicaid
Due to larger percentage of members with other insurance (COB)
Medicare
With opportunity for revenue maximization from risk adjustment and ESRD
ACA & Commercial
Based on Provider Contract Agreements and Payment Policies
Payment Integrity Services
Full service or subscription-based AI applications and consultative services
AI Applications
Full service or lease options available
- •Clinical Review
- •Data Mining Ideation
- •SNF, ESRD, Home Health and NDC
- •Facility ER Leveling
- •Medical Records Repository
- •Quality Measures
- •Recovery, Avoidance and Dispute
Consultative Services
Subject Matter Expert guidance and support
- •Payment Integrity Best Practices
- •White Papers, Policies and Ideation
- •Quality Improvement
- •Business Case Support and Strategy
- •Financial Accrual and Reconciliation
- •Data Repository and Metrics
- •COB
Safeguards
Enterprise security and compliance
- •Cyber Security Insurance
- •Cloud Based (SOC 1 and 2)
- •First Tier, Downstream, Related Entity (FDR) Ready
Company Metrics
Our growth and impact measured in numbers
Get In Touch
Connect with our experts to discover how Advice Healthcare can help you achieve your goals
Schedule a Demo
See our platform in action with a personalized demonstration tailored to your organization's needs.
Get ROI Assessment
Receive a custom analysis of your potential savings and ROI with our solutions.