We help Health Plans and PBMs fight fraud and protect revenue.
We find provider network inaccuracies and fraud you can’t, ensuring continuous eligibility and generating cost savings for your government lines of business.
Get More from Your Government LOBs
Protect Revenue and Drive Cost Savings
We empower plans to stop payment on ineligible claims before you lose revenue. Get powerful provider eligibility insights and immediate alerts when and where your teams need them.
Improve Business Process Efficiency
Our always-accurate data monitoring and flexible API/SSO integrations enable any team to access provider eligibility statuses and reports, without requiring overhaul of your current systems. Create collaboration and process efficiency for stakeholders across your organization, from provider enrollment and credentialing to provider network management, compliance, and payment integrity.
Ensure Enterprise Compliance
Empower a smarter FWA program in your government programs. Create your organization’s provider eligibility standards, customize by LOB or geography, and know as soon as a provider’s status changes. Answer any audit request with custom and pre-configured reports.
Power Data Transparency
Meet Dash, the smarter monitoring solution for payers.
Dash is the customizable, ongoing compliance monitoring solution for your par and non-par networks.
Say hello to Dash.
Spot FWA as quickly as possible through continuous provider monitoring and claims integration.
Top Seven Monitoring Challenges for Health Plans
Smart, integrated monitoring is the key to mitigating risk within provider networks. As health plans transition to ongoing eligibility monitoring, these are the top challenges they face.
Resources to help your team grow and succeed.
PECOS: What You Need to Know
PECOS plays a critical role in facilitating communication and data accuracy between providers and CMS. It powers several datasets indicating providers' statuses and standing with CMS.
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Get the latest healthcare compliance news, advice from industry experts, and all things related to OIG exclusions delivered straight to your inbox.
The Interoperability Rule and Effects on Provider Network Data
The Interoperability Rule, currently slated to go into effect in 2021, impacts provider network data for health plans in addition to significant implications for patient health data requirements.
