Specialty Claim Reviews

Reduce high-cost healthcare claim errors to help uncover savings others miss.

Targeted Accuracy

Focused Integrity

High-cost specialty claims are among the most clinically complex claims to review and can have significant financial consequences when inaccuracies occur.

Traditional payment integrity approaches can often miss clinically nuanced discrepancies, leaving health plans exposed to unnecessary spend on their highest-dollar claims.

Claritev offers a comprehensive suite of Post-Payment Integrity solutions that perform targeted specialty claim reviews to help identify inaccuracies, assess billing accuracy, and support improved payment integrity across the most impactful hospital and professional claims.

A Targeted Approach to Payment Integrity

Claritev’s Specialty Claim Reviews apply focused clinical and analytical expertise to the healthcare claims that likely represent significant financial exposure.

By combining targeted reviews with data-driven insights, we help:

Identify inaccuracies in high-cost claims

Evaluate appropriate billing and documentation

Strengthen payment integrity beyond traditional edits

Help expand review capacity without adding internal resources

Solutions Built for High-Cost Specialty Claims

Hospital Bill
Review

Identify potential waste and abuse in high-cost hospital inpatient claims using advanced analytics and targeted post-pay review.

High-Cost Drug Review

Evaluate drug claims billed under a medical benefit for diagnosis, dosing, coding accuracy, and appropriate billing practices.

Medical Implant & Device Review

Evaluate whether medical implant and device charges are supported by documentation and appropriately billed.

Focused Where It Matters Most

Not all hospital and professional claims carry equal risk. Claritev helps you direct attention and resources to the highest-cost medical and drug claims where even small inaccuracies can result in significant financial impact. Our targeted approach helps identify issues that may not be captured through traditional review methods.

Designed to Drive Measurable Outcomes

Specialty Claim Reviews were created with the following goals in mind:

Reduce overpayments on high-cost claims

Capture additional savings opportunities

Scale your program without increasing headcount

Improve accuracy across clinically complex services

Enhance clinical integrity and oversight

Creating clear paths to value.

Claritev insights, resources, and case studies.

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