Pre & Post-Payment Integrity
To Protect Healthcare Plans and Their Members
ClaimInformatics is a payment integrity vendor specializing in accurate claims analysis and revenue recovery designed to protect healthcare plans and their members...saving plans and members 5-25% of the healthcare spend.
Through proprietary software and program technology, ClaimInformatics can identify overbilling errors, track improper payments and error codes, and uncover medical fraud, waste and abuse. This HIPPA Compliant system provides new levels of accuracy and transparency for improved payment integrity. This state-of-the-art platform has been designed to provide a granular forensic review of all healthcare claim transactions. We handle recovery and reconciliation of improper payments as well as detection of fraud, waste and abuse. Our process incorporates an end-to-end solution with corrective action plans.
Payment Integrity That Works For You
Even if your plan has improperly paid claims, it’s not too late to identify overcharges and recover plan assets. Using the ClaimIntelligence™ platform to assist with recapturing assets, we respectfully and diligently collect, reconcile and deposit recouped funds.
ClaimInformatics filters out suspect claims and identifies overcharges before they are paid, by leveraging our proprietary pre-screening technology.
We review every claim that the plan has paid or might pay. (Other payment integrity firms look at only a small targeted set of data.) There are no cracks to fall through.
We are continuously supplementing and refining our hundreds of proprietary algorithms. This constant improvement has allowed us to catch errors at a rate five times the industry average.
With incredible accuracy, our exclusive Episode of Care Logic™ acts as a detective to identify claims where the wrong service code was billed.
Our sophisticated coding and data mining capabilities use a fully integrated rules engine to capture all national coding and payment guidelines applicable for state, federal, and private health plans. Our embedded Episode of Care logic transcends standard audit checks.
Healthcare is fraught with conflicts of interest, like “payment integrity” providers being owned by the insurance companies they’re supposed to monitor. ClaimInformatics is different; we are fully independent. We do not work with insurers, so our sole allegiance is to plans and their members.
Our Focus On The Members
The plans who hire ClaimInformatics are beholden to their members, and we share that commitment. While our post-payment solution returns money to the plan, we are the only firm that identifies and reports member overpayments. We give our clients real monetary wins they can bring home to their members.