Move beyond recovering payment errors after they happen. This white paper explores how connected payment integrity, powered by responsible AI and advanced analytics, helps health plans proactively prevent errors and improve financial performance.
Claritev’s recognition as a Leader in Everest Group’s 2026 Pre-payment Integrity Solutions PEAK Matrix® Assessment highlights its decades of expertise helping health plans improve payment accuracy, prevent costly errors before they occur, and reduce administrative burden through a powerful combination of AI, advanced analytics, and clinical expertise.
Claritev has identified more than $22 million in waste and abuse for clients through its proactive, data-driven approach to payment integrity. By closely analyzing infectious disease billing patterns—including rising trends in RSV and COVID‑19—Claritev helps organizations detect errors early, prevent overpayments, and strengthen protection against emerging sources of waste and abuse.
Stop overpaying on hospital claims. Our Itemized Bill Review (IBR) process uncovers billing errors on 98% of claims reviewed, delivering an average of 15% savings per claim. By identifying duplicate charges, non-covered services, and other discrepancies, IBR helps healthcare payors reduce costs and stay compliant with confidence.
By not performing coordination of benefits (COB) and data mining on their pharmacy claims, healthcare payors may be missing a significant opportunity to recoup overpayments.
ESRD premium restoration solutions help ensure Medicare Advantage plans are properly reimbursed for ESRD patients by identifying members with missing ESRD statuses and restoring the premiums. However, because of the low number of ESRD patients, small healthplans often underestimate the potential impact of using an ESRD premium restoration solution and decide against using one. This article explains why they should reconsider.
As a part of Claritev’s Payment Integrity service, we review claims to ensure there are no billing errors and that the charges make sense. When we find mistakes or suspicious charges, we investigate. This blog details findings that left us shaking our heads.
The future of healthcare payment integrity is here, and it’s powered by AI and machine learning. From detecting fraud to streamlining claims processing, these technologies are transforming how payors reduce costs and improve accuracy.
Explore how innovative payment integrity strategies are transforming healthcare by tackling waste and abuse. Discover the key drivers of inefficiencies in U.S. healthcare spending—from administrative overhead to claims errors—and learn how advanced technology, collaboration, and transparency can reduce costs, enhance patient experience, and strengthen provider relations.
