The right payment integrity solutions can right your bottom line

Consider your overpayments over.

All too often, health plans lose money due to a one-size-fits-all approach with a weak workflow — or none at all. What if it were possible to identify overpayments quickly and accurately?

Carelon’s customizable solutions meet payment integrity (PI) challenges head-on, offering tailored strategies that directly address our clients’ operational requirements and organizational goals.

Turn claims data into insights

Carelon has billions of data points from decades of processing claims. Yet data is only useful when it’s transparent and actionable. That’s what we do. Through advanced technology and consultative partnership, we deliver real-time reporting, trends, and feedback to help clients meet their payment integrity goals.

Responsive tools and live consultations
Our online workflow tool manages claim validations with real-time support from Carelon’s subject matter experts. Together, they offer:

  • Claim prioritization: high-value claims processed before expiration. 
  • Seamless collaboration: disputes and other overpayment issues efficiently resolved.
  • Customized workflows: tasks assigned based on team members' expertise.
  • Transparency: productivity and performance tracked by worker and concept.
  • Strategic insights: see which providers frequently make errors.

On-demand reporting
Informed by our analytic insights and decades of experience, Carelon’s reporting capabilities are uniquely responsive and customizable, producing:

  • Real-time insights: immediate access to current data for quick decision-making.
  • Customized filtering: tailored reports to pinpoint specific needs and focus on relevant data.
  • Operational efficiency: reports generated without waiting for batch processing.

True partnership
With a collaborative, responsive PI partner, health plans achieve more. We build trust through:

  • Transparency: clear, open communication that supports informed decision-making.
  • Flexibility: tailored solutions and the flexibility to ensure scalable and effective strategies.
  • Guidance: strategic, personalized advice to continuously improve PI efforts.

Strengthened health plan operations
The right payment integrity partner can make a significant impact, leading to:

  • Accurate claims processing: reduce fraud, waste, and abuse.
  • Improved financial health: optimize resource management and lower administrative costs.
  • Enhanced stakeholder relationships: better billing accuracy and transparency strengthens the relationship between the provider and member.

 

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