Identify, prevent, and recover improper payments with advanced clinical validation and data mining solutions—protecting billions in healthcare spend.
Payment Integrity ensures healthcare claims are paid correctly — the right amount, for the right service, to the right provider.
Thousands of procedure codes, diagnosis combinations, and ever-changing regulations make billing problematic without proper oversight.
Insurance companies and providers spend billions annually on claims processing, appeals, and payment disputes.
Overpayments, underpayments, and fraudulent claims contribute to rising premiums and reduced quality of care.
Our experience facilitates the creation of advanced algorithms and AI assisted validation for identifying errors and anomalies before and after payments are made.
Board-certified clinicians validate medical necessity. Ensuring claims meet evidence-based standards of care.
By preventing improper payments and streamlining processes, we help payers improve quality and reduce administrative costs.
AI-powered Prevention of overpayments, coding errors, and recovery opportunities.
End-to-end coverage for pre-pay and post-pay claims with advanced AI and Clinical expertise
With advanced algorithms and technology, we leverage AI to assist in the validation of DRG claims for pre-pay avoidance and post-pay recovery, as well as provider education for improved quality submissions. Expect 4-6% in IP savings when fully implemented.
7,500+ customizable pre-pay edits and post-pay recovery concepts across all claim types for 3-4% of all medical expenses.
Less than two midnights analysis delivering 2% DRG savings opportunity.
Learn More →Same day or within 30 days of discharge analysis delivering 2% DRG savings opportunity.
Learn More →Line-item review of high-dollar inpatient claims for duplicate charges, supplies, and outliers.
Learn More →Process millions of claims in real-time with our cloud-native architecture designed for enterprise scale.
Maintain full regulatory compliance with CMS, HIPAA, and state requirements. Built-in safeguards keep PHI secure across every workflow.
Typical clients see a minimum of 5x+ ROI within 12 months through reduced improper payments and operational efficiencies.
Seamless integration with all major payer systems — most health plans go live within 12–16 weeks, backed by 24/7 expert support from our clinical and technical teams.
Join leading healthcare payers saving billions with AI-powered solutions. Schedule a demo to see how we can help.