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.
Discover how Claritev is bending the healthcare cost curve by leveraging data analytics, technology, and industry experts to improve care value and combat rising healthcare expenses.
Payors face increasing complexities in healthcare claims. This blog explores the top five payment integrity challenges and offers strategies for overcoming them, enabling payors to improve financial outcomes and provider relationships.
As COVID-19, RSV and other infectious diseases have spread over the recent years, waste and abuse in healthcare claims billing relating to these conditions has increased. What is your payment integrity vendor doing to address this growing trend?