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.
Data Mining, a post-payment payment integrity service, detects errant medical claims in sets of data. Errant claims typically include duplicate payments and claims with billings issues that lead to overpayments. MultiPlan identifies errant claims by scouring the data. We use artificial intelligence, including machine learning and algorithms, to identify incorrectly paid claims and anomalies in the data. We also have subject matter experts on our data mining team review all findings to confirm the findings of the technology. All findings are presented to our clients for approvals.
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 our eye-popping findings.
Several companies offer solutions to help eliminate or reduce incorrectly paid claims and save healthcare payors significant dollars. So how do health plans choose which one to work with? The truth is many of the solutions are similar, and they’ll probably all save payors money. Answers to these questions help separate the players.
MultiPlan is honored its Dynamic Negotiation Offer solution has been awarded as the “Best Healthcare InsurTech Solution Provider” in the 7th annual MedTech Breakthrough Awards. The solution has advanced capabilities that utilize intelligent claims automation for a specified subset.
Coordination of Benefits (COB) review for healthcare payors involves more investigation than simply validating primacy for other coverage. A significant amount of detective work is needed to drive valid and actionable COB recoveries, especially when patients are newborns.
Claritev's PHCS Network is the largest independent, nationwide primary preferred provider organization (PPO). It is the preferred choice for health plans wanting a provider network with flexibility to meet their unique needs. Plans get administrative ease without sacrificing provider access, savings, and quality for health plan members.
Claritev explains what revenue integrity is via a short video.
As we look forward to the new year, we will see payors, providers, and consumers collaborating to improve the healthcare experience. One thing is a sure bet, healthcare will remain a dynamic industry with creative solutions emerging throughout 2023 and beyond.
While both human intelligence (HI) and artificial intelligence (AI) can be used by themselves to identify waste and abuse in healthcare billing, Claritev believes the most effective healthcare payment integrity solutions leverage both.