Reliable, Affordable Beneficiary Protection
Today it’s all too common to hear of union benefit and pension plans facing financial difficulty. One of the key factors leading to unfunded obligations is unplanned payments for healthcare. Payment Integrity is critical to control unplanned payments by curtailing billing errors, fraud, waste and abuse that may be siphoning capital out of the plan.
Our real-time, cloud based Payment Integrity Platform provides comprehensive tools including:
- Pricing leveraging UCR and all 16 Medicare Prospective Payment Systems to facilitate price negotiations and integrity checks
- UCR for Medicare gap pricing
- Advanced Medicare and Commercial analytics logic to assess payment compliance at a granular level
- Fraud, waste and abuse (FWA) detection at the beneficiary and provider levels