Payment Accuracy Solutions

Innovative, end-to-end payment accuracy product suite for payers that want to improve claims adjudication and streamline payment operations across all payment modalities.

Achieve Medical Cost Savings with Actionable Insights

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Drive down costs through accurate payments

Federal agencies estimate that more than $1 trillion is wasted throughout the healthcare system each year. With so much at stake, payers need analytics, insights and guidance through every step of the payment continuum. 

Our integrated end-to-end payment solutions, deep expertise, and commitment to customer service enable our clients to save billions of dollars annually in medical and administrative costs.

As your partner in driving value, we provide you with transformative insights for every stage of the payment process. We help you work better, faster, and more efficiently to deliver improved care and better outcomes at a lower cost.


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Improve payment integrity and transparency

As the industry leader in payment policy, intervention, and audit solutions, we:

  • Ensure the right solution is applied at the right time. We help you maximize your savings while minimizing provider abrasion.
  • Integrate analytics and artificial intelligence models to help you evaluate and flag your payment risk/vulnerability in relation to your tolerances.
  • Optimize control processes and models to assign appropriate solutions to your payment risk.
  • Implement visualization tools to improve transparency, helping you understand and control your solutions relative to payment risk.

 

Meaningful Insights Throughout the Payment Continuum

Powerful Analytics Engine to Drive Savings 
Prevent inaccurate claims

Our tools use an innovative analytics engine and robust messaging platform to provide messaging back to the provider at the time of claim submission. This integrated process reduces losses for high-volume, low-dollar claims; decreases overbillings; and changes outlier behavior. 

Our partners can increase their audit savings and improve their medical cost savings with no additional risk.

80.1% outlying providers exhibit more accurate billing and >$210M in total savings

Innovative Claims Management
Prevent inaccurate claims

Claims management is one of the most critical aspects of medical cost savings for a health plan. Our industry-leading clinical and payment management product, ClaimsXten, uses advanced rules and clinically sourced edits to enable payment innovation and drive medical and administrative savings. ClaimsXten is interoperable with a variety of claims processing systems.

ClaimsXten can help you:

  • Perform claim editing within the claims workflow
  • Automate manual workflows
  • Manage content supporting rule edits
  • Increase auto-adjudication rates by ~4%
  • Reduce appeals by up to 30%.

Savings rate averages 3-8% of total paid dollars

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