Today’s complex health plan environment opens the door for payment integrity issues, including Fraud, Waste, and Abuse (FWA), because you must analyze huge data loads, coordinate payments to multiple carriers and manage a wide range of health plans across government and commercial clients. FWA leads to higher costs for you – and higher co-payments and premiums for members.
We, along with our strategic partners, deliver solutions that use workflow automation and dashboards so you can proactively detect and investigate non-payable claims. We can help you capture more revenue and automate payment authorizations with proven toolsets for screening, scoring and coordinating benefits. Our solutions allow you to improve pre-pay screening and scoring for direct savings and scan for program irregularities and billing anomalies. Plus, you can use advanced analytics to improve audit and recovery results and increase referrals using provider risk scorecards.