Claritev and Claims Care Revenue Cycle Management, a Burjeel Holdings Company, sign an MoU to bring the US-based Claritev’s solutions to the MENA region and collaborate on revenue cycle management capabilities
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.
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?
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.
Claritev explains what revenue integrity is via a short video.
Ben Perryman and Evan Pollack of MultiPlan speak on the combined approach to using both artificial and human intelligence in payment integrity efforts at the NHCAA Institute for Health Care Fraud Prevention’s Annual Training Conference.