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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 and/or Network protects plan assets against overbilling, fraud, waste, and abuse.
Frank Tecumseh, Vice President of Human Resources Firekeeper's Casino & Hotel
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“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.”
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 overpayments and recover plan assets. Using the ClaimIntelligence™ platform to assist with recapturing assets, we respectfully and diligently collect, reconcile and deposit recouped funds. This process recovers 5%-15% of paid plan assets.
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“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
We Stand By Our Clients & They Stand By Us
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