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Pre & Post-Payment Integrity

To protect Healthcare Plans
and their Members

Saving Plans & Members 5-25% of their Healthcare Spend

“Armed with the transparent results ClaimInformatics provided, we were able to see
how our TPA was actually performing. Now we
have the tools to hold our third-party
administrator accountable.” 

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Frank Tecumseh

Vice President of Human Resources Firekeeper's Casino & Hotel

Understand how to identify and
defeat six types of overbilling errors that are driving premiums up
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Health plans are facing a triple threat

Rising
Healthcare Costs

American healthcare spending recently eclipsed $4T USD, spurred by improper payments and billing firms that are incentivized to maximize provider reimbursement at all costs.

Increasing Improper Payment Rates

According to the Centers for Medicare and Medicaid Services, improper payment rates have ballooned from 9% in 2018 to 21% in 2020. Some
officials admit that the real number may be closer to 27%.

ERISA Risks

Plan administrators and fiduciaries are ultimately responsible for ensuring compliance, and that their TPA or Network protects plan assets against overbilling, fraud, waste, and abuse. 

“The ClaimInformatics team understands the ins-and-outs of medical billing better than any group with whom I have worked. Their technology uncovers fraud, waste, and abuse that other systems miss completely.”

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Michael Poelman

President

Novo Benefits & Apta Health

See a forensic analysis of exactly how providers and TPAs used six specific instances of overbilling to collect over $300,000 in overpayments
Our Solution

Payment Integrity
That Works For You

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Post-Payment

Even if your plan has improperly paid claims, it’s not too late to identify overcharges and recover plan assets. Using the ClaimIntelligence™ platform to assist with recapturing assets, we respectfully and diligently collect, reconcile and deposit recouped funds.

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Pre-Payment

ClaimInformatics filters out suspect claims and identifies overcharges before they are paid, by leveraging our proprietary 

pre-screening technology.

We Stand by our Clients & They Stand by Us

“CI’s payment integrity program has helped MLBF identify an extraordinarily large amount of overspending and inefficiency we would otherwise not have found. I’d recommend CI to any funds looking to root out overpayments or inefficiency in health benefit costs”

— Lou Mandarini, Administrator
Massachusetts Laborers Benefit Fund

“As an ERISA attorney, CPA, and healthcare consultant, I’ve seen organizations claim to deliver payment and cost reduction. ClaimInformatics stands out because they actually delivered on their promises. We highly recommend ClaimInformatics!”

- Tony Sorrentino, Chief Compliance Officer
Silverstone Group

What's new

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Prevent & Recover Improper Payments Today

Ready to claim your money back? Book a free, no-obligation consultation today!