Innovations in AI and machine learning unlock opportunities to eliminate waste, reduce costs, and make healthcare more affordable. Claritev offers the best of both machine power and human power to help Medicare Adavantage plans ensure the accuracy of CMS premiums.
Surprise billing has created significant challenges for healthcare payors, increasing costs and administrative complexity. The No Surprises Act aims to protect patients while shifting payment disputes to payors and providers, making it essential for organizations to understand its impact on reimbursement, negotiations, and the overall claims process.
Expanding on one of the top payment integrity trends for 2021, this blog post focuses on growth in Medicare Advantage enrollment and the revenue integrity challenges it brings for health plans.
We explain the many revenue integrity challenges health plans face and walk through a variety of client examples illustrating the breadth of value obtained in premium restoration from our Medicare Secondary Payer Validation and End-Stage Renal Disease Premium Restoration solutions for our health plan clients with varying member sizes.
The old tried and true approach to coordination of benefits isn’t enough anymore. Claritev’s Coordination of Benefits (COB) solution blends the right people, processes, and tech, allowing our team and clients to work smarter rather than harder.
Members with End-Stage Renal Disease (ESRD) significantly impact your Medicare Advantage plan—learn how to navigate the complex process for recovering millions in underpaid premiums.
Claritev discusses what is in store for the future of payment integrity and how the company is helping clients make the transition from retrospective to prospective programs.
Everyone wants a return to normal. But given all we’ve experienced during this pandemic, going back to “business as usual” seems unlikely. Here are four ways COVID-19 has changed the billing landscape and what we can expect for the future.
For today’s health plans, clinical audits play a critical role in payment accuracy and ensuring the financial health of the organization. They can help a plan control costs, comply with government regulations, and meet financial requirements. Transparent communication and education are key to positively impacting the provider experience during clinical audits.
With vaccines offering hope that we’ll put the COVID-19 pandemic behind us sooner rather than later, employers are beginning to think about how they can dramatically reduce the cost of healthcare benefits while keeping employees happy. Claritev’s Vistara offers an attractive option.