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.
DRG Validation
Our DRG Validation solution uses clinical expertise and advanced analytics to detect coding discrepancies on inpatient claims that can lead to overpayments, helping health plans improve payment accuracy and reduce unnecessary costs. By validating that the assigned DRG is supported by the medical record, we help improve reimbursement accuracy while strengthening payment integrity and compliance.
Industry Leader Recognition
Claritev has been recognized as a Leader in the Everest Group Pre-payment Integrity Solutions PEAK Matrix® Assessment 2026, highlighting the company’s leadership in connected payment integrity, responsible AI, and technology-enabled solutions that improve payment accuracy.
Why Pre-Payment Integrity Matters More Than Ever
Chief Operating Officer, Jerry Hogge, explores why payment integrity is critical to reducing costs, improving accuracy, and strengthening payer-provider relationships as healthcare claims grow more complex.
Engaging insights.
New ideas, proven best practices, and fresh perspectives for the healthcare ecosystem.
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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.