Pre-Payment Integrity
Combining automated technology and human intelligence to address clinical billing challenges.
Error Prevention
Cost Control
Identifying potential errors and helping clients address waste and abuse.
Pre-payment integrity doesn’t have to be complicated or costly. Claritev helps address everything from identifying simple coding errors to complex clinical billing issues, bringing greater transparency and confidence to the payment process.
By bringing together advanced analytics with hands-on clinical and coding expertise, we can identify issues that traditional edits may miss and potentially resolve them to help avoid waste or provider friction.
How Claritev creates a difference in pre-payment integrity:
We go beyond automation.
Clinical review is integrated into our pre-payment integrity solution.
We know pre-payment.
Claritev brings over 45 years of pre-pay experience.
We know how to identify waste & abuse.
With our long track record in the healthcare space, we have seen some of the most creative billing schemes.
We know providers.
Our team works with 1.4 million practitioners and facilities.
We’re clinically focused.
We involve clinicians at every step, every day.
We’re a trusted partner.
Over 300 payer clients depend on Claritev for pre-payment clarity.
Supporting pre-payment integrity with data-driven solutions and expertise.
Advanced Code Editing
Advanced Code Editing (ACE) uses intelligent automation and expert clinical review to detect coding errors in both in-network and out-of-network claims.
Clinical Negotiations
Clinical Negotiations involves identifying billing errors, consulting with clinicians, and engaging Claritev’s specially trained negotiators to work toward fair payment reductions. Providers ultimately sign off on reductions, which helps decrease balance billing of members.
Itemized Bill Review
Our Itemized Bill Review (IBR) service helps you find high-dollar claims, review specific cases you choose, or use both methods together. We focus on complex billing issues such as duplicate charges or miscoded services and can recommend or negotiate appropriate reimbursement.
Engaging insights.
New ideas, proven best practices, and fresh perspectives for the healthcare ecosystem.
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On-Demand Webinar: Beyond Recovery: Designing the Next Generation Payment Integrity Program
Recoveries have long defined payment integrity success—but they only tell part of the story. This webinar challenges the traditional recovery-focused approach and introduces a…
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The No Surprises Act at a Crossroads: From Protection to Performance
No Surprises Act independent dispute resolution (IDR) volume is driving healthcare administrative costs—it’s time to shift from policy execution to system optimization. Explore how leaders…
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On-Demand Webinar: Final Rule – Navigating NSA Independent Dispute Resolution Operations
CMS’s latest IDR Operations Final Rule brings important changes to the No Surprises Act dispute process. This webinar highlights key updates, workflow impacts, and…
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How can Claritev bring clarity and integrity to your pre-payment processes?
Learn how Claritev can help you improve payment accuracy and eliminate wasteful spending.