What Is Payment Integrity In Healthcare?
Payment integrity is crucial for maintaining the financial health of and preventing unnecessary costs.
top of page
OUR PAYMENT INTEGRITY SOLUTION
How to Prevent Fraud, Waste, & Abuse (FMW) in Healthcare
Transforming Payer-Provider Transactions
& Navigating Payment Integrity Seamlessly
Our payment integrity solution utilizes artificial intelligence (AI) and machine learning (ML) to provide a real-time healthcare fraud, waste, and abuse (FWA) automated detection and prevention solution.
Our advanced technology solution will enhance your FWA detection capabilities. This innovative tool helps identify patterns, outliers, and suspicious behaviors that may indicate potential fraud.
Our real-time FWA detection system was developed through a combination of the following attributes:
Using this unique combination, we have developed a multi-vectored (multiple angles/scenarios/algorithms) approach that reviews all medical claims from all providers within hours, detects, and provides the exact details of -
Who, What, When, Where, and How FWA is committed.
This unique multi-vectored payment integrity approach is administered post-adjudication and pre-payment saving the healthcare payer millions of dollars.
Clinical Knowledge
Informatics
Forensics
Information Technology
Designed to Reduce Abrasion & Improve Relations With Your Network
The PRMS encompasses a suite of advanced functionalities, including:
Communication Platform:
Ensures secure, fully automated, real-time communication with providers, streamlining the exchange of crucial information.
Provider Engagement:
Minimizes the risk of provider abrasion, optimizing the efficiency of FWA programs by maintaining transparent and effective communication channels.
Education Hub:
Delivers a wealth of educational materials to providers, fostering awareness of fraud, waste, and abuse prevention strategies. This initiative promotes a culture of compliance and shared responsibility within the healthcare network.
Monitoring Support:
Offers assistance for credentialing and licensing through proactive monitoring, identifying and addressing potential issues before they escalate.
Calculate Your Savings
STREAMLINE MEDICAL CLAIM REVIEW
The healthcare sector in the U.S. has consistently been a prime target for Fraud, Waste, and Abuse (FWA) - even before the pandemic occurred.
Our payment integrity solution is designed to proactively identify potential FWA issues before a medical claim is processed, employing advanced data analysis techniques. By doing so, our solution enhances overall efficiency, reduces costs, and contributes to the satisfaction of both clients and members.
bottom of page