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.
In this post, we’ll provide a framework for refining ownership of provider data and eligibility monitoring in your organization and explore the most common accountability structures we see with health plan clients.
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In this conversation with data and policy analyst Allan Baumgarten, we discuss the key differentiating areas of procurement, contracting, and oversight, and where these may be headed.