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Improve quality and reduce the total cost of care with our interoperable 护理管理 platform — built on a foundation of automation, 标准化和成熟的流程和 使用著名的, industry-standard COTS products like the Johns Hopkins ACG® System as well as administrative and clinical information.

Identify coding, location, level of service and reimbursement errors pre- or post-pay. Our 临床索赔审查 solution uses artificial intelligence to select the claims most likely to have errors and clinical expertise to compare them against medical records.

Simplify provider billing with comprehensive validation rules for managed care and fee-for-service transactions and ensure your encounter data is compliant through a single point of submission.

Verify member eligibility while providing clarity on the decision to staff — ensuring they can explain, 与敏感性, 为什么有人不符合资格.

Gain end-to-end support in the identification of fraud, waste and abuse. 十大正规赌博平台大全的模块化, cloud-hosted platform exposes issues through clear visualization and easy-to-navigate exploration tools.

Pinpoint claims that have been improperly billed or paid while minimizing abrasion in the process. Our 付款方式分析 solution uses proprietary data analysis tools to compare claims history across many criteria that client systems or claim processors often miss.

Capture and recover dollars lost as a result of improperly paid claims. Our Post-Payment solutions leverage AI and machine learning to ensure accuracy in the claims review process and efficient, digital processes to pursue recoveries and maximize savings.

最大限度地避免你的计划或项目的成本. Our tenured market expertise pairs with our end-to-end COB solutions to amplify speed to delivery and provide truly actionable insights.

Automate and expedite authorizations for your state with configurable rules and workflows designed to improve member and provider satisfaction.

Create new efficiencies within provider management processes, from initial enrollment through final determination letters to support participation in fee-for-service and managed care programs.

Validate the appropriateness and necessity of services and procedures to contain costs in your plan or program. 利用管理 addresses your most pressing needs by combining cost management with accurate pre- and post-payment claim reviews and prior authorization from our Clinical Care Reviews.