Payment Integrity

Recover, eliminate, and prevent unnecessary medical-expense spending for your health plan and your members

Join the next era of payment accuracy

Payment integrity is an effective strategy to control costs without compromising care. But yesterday’s approaches are no match for the complexity of today’s challenges. Our next generation of solutions focus on preventing errors before claims are paid for greater efficiency, better experiences, and improved costs.

We’re at the forefront of payment integrity, accelerating its evolution. We’ve taken what we’ve learned through decades of experience to offer you new solutions powered by deep data sets, ground-breaking technology, and sophisticated analytics. But our real power comes from our team of approachable experts who understand what true partnership is all about. Our team meets you where you are, making the path to a more effective and efficient payment integrity strategy easier to navigate.


It’s time to get excited about payment integrity

On the surface, the subject of claims payment accuracy may sound a bit dry and technical. We find it fascinating. We see that payment integrity offers incredible potential to tackle one of the biggest challenges for health plans — and our healthcare system: affordability. To achieve this, we break down barriers, partner like never before, and keep humanity at our core. It's this vision, collaboration, and integrity that set us apart.

Expertise

Since we live and breathe healthcare, we design and deliver solutions that maximize results and support your valuable member and provider relationships.

 

Powerful technology

Advanced analytics driven by artificial intelligence and machine learning power our solutions for unmatched accuracy and efficiency. Plus, our next-gen technology is backed by a team of seasoned experts who partner with you every step of the way.

 

Full transparency

It’s critical to see how your payment integrity program is performing. That’s why we provide access to easy-to-read dashboards to monitor your program’s progress and provide insights that optimize results.

 

  

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Take payment integrity
to the next level

Our solutions bring together breakthrough technology and human expertise to help speed your ability to drive cost savings and value for your stakeholders.

Claim Anomaly Detection Solution


Find and resolve claim errors faster and more accurately.

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Coordination of Benefits Consensus Solution


Quickly identify members with multiple coverage and make accurate coverage determinations.

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Subrogation Solutions


Streamline recovery through our structured, proven process. Explore our offerings:

Full-Service Subrogation

Subrogation Case Identification

Subrogation Overflow

Workers' Compensation Recovery

  

Ask us about payment integrity

Health plan leaders, contact us to learn more about the possibilities and impact of payment integrity.

Are you a health plan member?

If you’re a health plan member and have a question about your health plan, please call the member services number on the back of your health plan ID card.