Vast Experience in Multiple Markets

ClaimInformatics provides services to a range of client types. If your organization has responsibility for healthcare or pharmaceutical claims, we can help. We are the claim payment recovery expertsOur unique approach includes returning improper payments to both the sponsor organization as well as the patients/members. We’ll help you to reduce errors and improper payments from happening in the first place.

Healthcare Claim Payment Recovery Experts

ClaimInformatics understands the nuances of working with local and regional governments. Our flexible approach allows us to customize our solution while meeting the strictest requirements of your regional or local government. Our procedures include governmental compliance, including both Medicaid and CHIP (Children’s Health Insurance Program).

Multiple Employer Welfare Funds have their own unique challenges resulting from the number of interested parties. Our flexible approach is tailored to each engagement, maximizing benefit for our clients and their members. Our dedicated account teams are staffed with professionals who have decades of experience supporting employers of all shapes and sizes.

Our experienced account teams support the unique needs and fiscal challenges of federal clients with a portfolio of solutions that drive down costs. We have the expertise, scale and operating models to meet complex Federal requirements.

We have the experience, expertise, and flexibility to help self-funded plan sponsors meet their fiduciary responsibility. Our dedicated account teams are staffed with professionals who have decades of experience supporting large employers. We have worked with carriers and third-party administrators across the country, supporting tailored solutions including platform integration with healthcare providers and payers. Most of all, we are committed to bringing transparency, accountability, and operational effectiveness.

Third-Party Administrators

Backup For Even The Most Robust Payment Systems

Advanced analytics technology provided by ClaimInformatics optimizes existing internal and external TPA pre-payment programs.

Real-Time Single Platform Integration

ClaimInformatics is a comprehensive system which identifies and recovers improper healthcare and pharmaceutical claim payments with automated reconciliation and reporting. The integrity of core source data between TPA and ClaimInformatics is never compromised and resides on one unified system.

Secure Web Portal Access

TPAs can access their client’s data through a secure, web-based portal that allows for enhanced reporting capabilities with customizable dashboards at no additional cost.

Validation for Prepayment Programs

The post-payment methodology we use at ClaimInformatics provides insight into the effectiveness of your pre-payment program.

 

On-going measurement of key metrics and integration results between post-payment and pre-payment systems require highly skilled experts and precision technologies, which we have. We use data to strategically help our clients improve asset retention and reduce risks.