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Category: Payment & Revenue Integrity Solutions

  • Pink and blue background with wooden building blocks set upon background in a stepped up formation, hand adding final block

    Building Blocks to Help Healthcare Payors Thrive in Our New Normal

    Healthcare payors are navigating uncertainty in the “new normal,” facing challenges like shifting claim volumes, cost pressures, and limited resources. By leveraging flexible, customizable building blocks—such as network-based, analytics-driven, and payment integrity solutions—organizations can adapt to change, maintain financial control, and strike a balance between cost savings, provider relationships, and member satisfaction. [claritev.com]

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    Machine Learning Drives Efficiencies at Claritev

    Machine learning is helping drive efficiency and accuracy across healthcare operations by enabling systems to learn from data and automate complex processes. At Claritev, this technology is used to prioritize claim reviews and enhance payment integrity, allowing teams to focus on high-value tasks, reduce manual effort, and scale operations while delivering greater value to clients.

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    Case Study: Fixing vs. paying improper charges

    Claritev analysis uncovered opportunities for a third-party administrator using a variety of PPO networks to: improve payment accuracy – too much was being missed in the existing editing process; gain control over clinical billing waste and abuse; and minimize provider abrasion to preserve leased network relationships.

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    Case Study: Extending the Power of Bill Review

    Claritev analysis showed a property and casualty servicer how it could strengthen its bill review and network services by: using analytics tuned to find wasteful or abusive medical billing practices not identifiable by more automated bill review programs; implementing resolution strategies appropriate for the severity of issues and nature of the provider relationships.

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