Payment Integrity and Risk Adjustment Solutions

Empowering health plans with better support, comprehensive tools and advanced technology.

Payment Integrity Solutions

We’ve developed a complete end-to-end solution that empowers payers to finalize reviews for maximum savings and recoveries in under 15 minutes.

Itemized Bill Reviews

Our 15-minute Itemized bill review capabilities include itemized bill editing, customizable denial libraries and feature-rich review functionality.

Automatically identified denials are presented to the user for validation
Dependable reviews equipped to handle any provider billing format
Robust search and filter functionality allows users to quickly identify items across various pages of records

Clinical & DRG Validation

Our DRG Validation tool offers analysts pre-screen rules designed to select the claims best suited to payers’ unique review programs. Rules are tailored to fit specific needs of your provider contracts and plan design.

Consistent denials help reduce provider appeals over time
Workflow controls route claims to appropriate team members
Built-in DRG calculation for every claim

Measurable Metrics

Cloud-Based

Repeatable Results

Pre-Screen Rules

Smart Routing

Risk Adjustment Solutions

Our technology enables the completion of Risk Adjustment reviews with all the efficiency of data-supported diagnosis extraction and HCC mapping. Harness the power of automation with a program that delivers results consistently and accurately.

Clinical Data Extractions

Our Advanced Machine Learning NLP technology processes unstructured and structured documents to extract key data insights, reducing the time it takes to perform chart reviews.

Data Supported Diagnoses

Solutions that allow users to capture supporting documentation for each diagnosis, ensuring accurate and defensible results.

HCC-ICD Mapping

Extract data longitudinally and map ICD to HCC codes while considering reporting period, version and other key elements.

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Extract Meaningful Data

Sometimes all you need is data, and when 80% of it is unstructured, in different formats and in various locations, it can be difficult to extract meaningful insights. Using Advanced Machine Learning NLP Technology, we process records one time, extracting semantically accurate and interoperable data to feed your analytic models.