Let's evolve from pay-and-chase and reduce the cost of claims overpayment.
Get in front of ineligible claims due to OIG exclusions, invalid licenses, and more.
Defend the integrity of your government LOBs.
Between $68 and $226 billion is lost annually to Fraud, Waste and Abuse (FWA). With monitoring that is both smarter and faster, you can catch exclusions and other issues hiding in your provider network—among par and non-par providers alike.
Control expensive recoupment efforts.
Traditional methods of claims recovery can quickly escalate the cost of the claim. Our enriched primary source data and superior matching algorithms spot potential FWA faster and deliver the documentation and evidence you need to respond to ineligible claims before they're paid—all without bogging down your team.
Take action sooner to defend your network and members.
Speed to action is critical for pre-pay screening. That's why we've designed our provider network monitoring to deliver fully verified eligibility alerts weeks or even months before another solution. Get your provider insights in your system of record via seamless and secure integrations.
Connect pre-pay screening with post-pay monitoring for better insight.
Pre-pay analytics and FWA screening are traditionally disconnected from ongoing provider monitoring and continuous credentialing. We monitor your entire provider network and connect every provider’s eligibility status in real-time with your existing systems, improving payment integrity and alignment across teams.
We’ve been able to design a daily workflow in our SIU that helps us spot potential fraud before we process a claim and also allows the SIU to identify and recoup claims that were paid to sanctioned or excluded providers.
Top Seven Monitoring Challenges for Health Plans
Smart, integrated monitoring is the key to mitigating risk and preserving program integrity. As health plans evolve to ongoing eligibility monitoring, these are the top challenges they face.
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Integrate smarter provider data into your existing systems and workflows for real-time results.
Resources to help Payment Integrity teams grow & succeed.
Provider Network Monitoring Solution Guide
In this guide, we define how a proactive approach to provider network eligibility helps payers create greater efficiency and profitability within government programs, reduce the risk of ineligible claims, and improve interoperability.
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Cheatsheet: Claims Leakage in Non-Par Networks
Claims leakage in non-par networks should be on the radar of health plan leaders as an important and solvable challenge. Find out why.
