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.
Claritev analysis helped a third-party administrator defend against a competitor’s push to implement Medicare pricing by: significantly improving savings for the employer and its members; engaging important providers in the new process; and preserving the community’s provider-patient relationships.
An auto medical services provider wanted to distinguish its network-based cost management program to sensitive auto insurance carriers by demonstrating: minimal provider noise through the use of network contracts to reduce medical cost; effective dispute resolution processing.
A health plan facing tight deadlines needed rapid access to providers to meet network adequacy requirements. By leveraging existing contracted providers and targeted credentialing strategies, Claritev enabled faster network expansion—helping the plan meet compliance requirements, accelerate market entry, and maintain flexibility for future growth.
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.
A workers’ comp services provider needed help maintaining State Certified Managed Care programs by: eliminating provider coverage gaps in geographies not addressed by its proprietary network; strengthening coverage for key medical specialties.
MultiPlan appointed Karen Eaton as Vice President of Sales and Account Management for its Government segment, leveraging her extensive experience to drive growth and expand solutions for federal and public healthcare programs.
To improve competitiveness, a regional provider-owned health plan needed assistance with: extending network access for its highly mobile membership, containing out-of-network medical cost, and preserving its relationships and reputation with the local provider community.
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.
MultiPlan achieved HITRUST CSF® certification for its data transmission and service portal applications, reinforcing its commitment to managing risk, strengthening security controls, and meeting rigorous compliance standards for protecting sensitive healthcare data.