Our state-of-the-art ClaimIntelligence™ platform is unparalleled

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100% of Claims

Whereas other payment integrity firms look at only a small targeted set of data, we review every claim that the plan has paid or might pay. There are no cracks to fall through.

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Continuous Improvement

We are continuously supplementing and refining our hundreds of proprietary algorithms, which have allowed us to catch errors at a rate five times the industry average.

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Episode of Care Logic

With incredible accuracy, our exclusive Episode of Care Logic™ acts as a detective to identify claims where the wrong service code was billed.

Post-Payment

ClaimInformatics identifies previously improperly paid claims and recovers those assets on behalf of the plan. We manage the entire process from identification to deposit.

This phase of our process acts as a feedback loop by identifying vulnerabilities in your existing pre-payment filters and payments systems, recommending gap-closing measures for more accurate front-end processing.

Best of all, ClaimInformatics clients only pay a percentage of amounts successfully recovered.

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We recover at a very high rate

We Catch Mistakes Other Programs Miss

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With very few appeals by providers
 
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“I have taken a hard look at every payment integrity vendor out there. And ClaimInformatics is, bar none, the best provider I have seen. Their platform is incredibly advanced, and their ability to recover on plan assets also sets them apart. They don’t just review data – they deliver actionable results that provide their clients with the confidence that they are being excellent financial stewards. I wish I had this during my tenure at Health and Human Services.”

- Gary Alexander, Former Secretary Health and Human Services of Rhode Island,
Medicaid Director of Rhode Island, and Secretary of Human Services in Pennsylvania

Pre-Payment

In a pre-payment environment, ClaimInformatics can deny suspect service codes before you or your members pay a cent.

 

 Using more than 3 million industry-standard rules coupled with hundreds of proprietary algorithms, we analyze your claim submissions in real-time to ensure billing and coding compliance. 

 

While a good post-payment solution can recoup money that was already spent, the best way to protect your members and plan is to prevent improper payments from ever occurring.

And with a guaranteed 2 to 1 ROI, ClaimInformatics pre-payment is no-risk.

This TPA did a great job of filtering improper bills.
We still found over 10% of what they passed through to be questionable or objectionable.

ClaimInformatics Pre-Payment Stops
the Bleeding Before it Occurs

 
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 Why We Stand Apart

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Our Platform

Our sophisticated coding and data mining capabilities use a fully integrated rules engine to capture all national coding and payment guidelines applicable for state, federal, and private health plans. Our embedded Episode of Care logic transcends standard audit checks.

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Our Independence

Healthcare is fraught with conflicts of interest, like “payment integrity” providers being owned by the insurance companies they’re supposed to monitor. ClaimInformatics is different; we are fully independent. We do not work with insurers, so our sole allegiance is to plans and their members.

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Our Focus On The Members

The plans who hire ClaimInformatics are beholden to their members, and we share that commitment. While our post-payment solution returns money to the plan, we are the only firm that identifies and reports member overpayments. We give our clients real monetary wins they can bring home to their members.