Solutions & Services

How We Help

Our goal is to simplify and streamline your claims payment integrity and cost-containment efforts. To do that, we’ll use our proven solutions while working with you to explore innovative options and customized programs that address your needs. Together, we’ll figure out the best way for your organization to maximize savings along the claims payment continuum.

Our Services & Solutions

We have a range of services that spans the claims payment cycle and digs deep to positively impact your financial performance — from prevention of mispayment to verifying your members’ information to recovering billions of dollars.

prospective-claims-accuracy

Prospective Claims Accuracy

PreVent is a proactive, post-adjudication auditing solution that identifies and corrects claim inaccuracies before payments are sent to the provider. A rapid turnaround time allows PreVent to seamlessly integrate with your daily or batch payment cycle.

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retrospective-claims-accuracy

Retrospective Claims Accuracy

With three decades of growth and continuous fine-tuning, our proprietary data-mining application identifies a wide range of overpayments: coordination of benefits (COB), contractual errors, duplicate payments, eligibility issues and many others.

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overpayment-recovery

Overpayment Recovery

A perfect mix between positive relationships and efficient technical modeling makes our recovery approach relentlessly effective. Our proven strategy will maximize your return and ease the burden of overpayment recovery for you and your providers.

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subrogation

Subrogation

Proprietary software and expert analysis helps our team quickly identify and seek reimbursement from all sources that may be liable for claims you have paid. We cast a wide net to identify more cases, which leads to greater recoveries on your behalf.

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coordination-of-benefits

Coordination of Benefits

Discovering other insurance and determining your payment liability is complicated and constantly changing. We make it easier for your team. Our end-to-end COB services deliver savings at every point along the COB continuum.

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survey-services

Survey Services

We’ll reach out to your groups and members to identify and validate important information leading to accurate claims payment. Proactive outreach improves quality and compliance, and enhances your provider and member experience.

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