Government

Federal healthcare agencies operate in an environment of heightened scrutiny and constant change. Expanding oversight, fluctuating budgets, and policy shifts demand rapid operational adjustment. At the same time, agencies must reduce fraud, waste, and abuse while safeguarding beneficiary access to care and quality of care.

Claritev understands government healthcare complexity. We work within regulatory frameworks, legacy systems, and funding constraints to help agencies:

• Identify patterns of fraud and distinguish fraud from error
• Reduce improper payments while supporting prompt payment to legitimate providers
• Strengthen auditability and oversight reporting
• Adapt operations as policy, regulatory, and market conditions evolve
• Improve financial resilience without compromising beneficiary care

We transform complex healthcare data into clear, actionable insights, helping enable better decisions that protect government programs and, in turn, the people relying on them.

Claritev helps federal healthcare agencies accomplish more with the resources they have, allowing programs to remain strong, accountable, and sustainable.

Solutions built to integrate with existing systems and regulatory frameworks, supporting measurable results without unnecessary operational disruption.

Payment and Revenue
Integrity Solutions

Our comprehensive pre-payment and post-payment solutions are designed to help identify improper billing patterns and reduce waste and abuse — while working within federal regulatory frameworks and aiming to minimize provider abrasion. Featured solutions include Advanced Code Editing (ACE) and Coordination of Benefits (COB).

Network Solutions

Our NCQA-accredited national PPO network of 1.4 million healthcare providers features our pre-payment integrity solution embedded into the network delivery model. Flexible network design enables seamless beneficiary access while helping achieve measurable cost savings, access stability, regulatory confidence, and cost control without compromising quality.

BenInsights® Performance Intelligence & Decision Support

BenInsights combines advanced analytics insight and clinical risk management to help employers proactively manage healthcare costs, support oversight of fiduciary responsibilities, and strengthen plan performance — with less administrative complexity.

How we support distinct missions across federal healthcare.

Claritev strives to align its capabilities with the unique priorities of major federal healthcare programs.

Centers for Medicare & Medicaid Services (CMS)

Strengthening program integrity, advancing transparency mandates, and enabling data-driven decisions that protect resources for millions of Americans.

U.S. Department of Veterans Affairs (VA)

Supporting stewardship, accountability, and financial sustainability so resources reach the Veterans who have earned them.

Defense Health Agency (DHA)

Enhancing mission readiness through payment accuracy, price transparency, and predictive analytics that support military members and their families.

  • In a remote community like ours, we do not have local access to every type of medical specialist. The MAVEN Project gives our providers a trusted resource when a patient’s care would benefit from specialist input and helps us make better-informed decisions about whether someone truly needs to travel off island. This grant means we can continue that support for another year.

    Chief Executive Officer, Kodiak Community Health Center

    Olivera Wilson

  • When someone comes through our doors with a serious or uncertain condition, every minute matters. Having portable ultrasound available at the bedside will give our clinicians another important tool to understand what is happening and make decisions faster. We are incredibly grateful to Claritev Cares and to our community for helping us get this across the finish line.

    Chief Executive Officer, Fairfield Memorial Hospital

    Andy Flemer

  • Rural healthcare organizations know exactly what would make a difference for their patients. The challenge is often finding the resources to make it happen. These grants help close that gap. One will put important diagnostic technology directly at the bedside, and the other will help patients benefit from specialist expertise without automatically having to leave their island community.

    Executive Director, Claritev Cares

    Andrew Loudner

  • Accurate payments help reduce unnecessary administrative costs, support stronger payer-provider relationships, and contribute to a healthcare system that promotes affordability and predictability for the people who depend on it every day.

    Chief Operating Officer, Claritev

    Jerry Hogge

  • Claritev’s broad pre-pay value chain coverage and clinical negotiation experience give it a foundation to support payers on upstream payment accuracy needs.

    Vice President, Everest Group

    Ankur Verma

  • The grant money we received from Claritev was used to support additional resources that allow our respiratory therapists to spend more time empowering and educating patients.

    Lisa Emery

    Director, New River Health Association Breathing Center

  • These resources were created to help military and veteran caregivers more easily understand options for meaningful mental health care for themselves and their families. Caregivers shoulder extraordinary responsibilities every day, and they deserve clear, trusted guidance that helps them navigate complex healthcare systems with greater confidence.

    Steve Schwab

    Chief Executive Officer, Elizabeth Dole Foundation

  • This collaboration (with the Elizabeth Dole Foundation) reflects a shared commitment to helping military and veteran caregivers navigate mental healthcare more clearly and confidently. These families have given so much in service to our country, and they deserve resources that are practical, accessible, and grounded in empathy.

    Carol Nutter

    Board Chair of Claritev Cares & Chief People Officer, Claritev

  • Your team is great at building trust. I have had nothing but a positive and efficient experience.

    Manager

    Large Midwest health plan

  • These are really important things that we wouldn’t be able to do without a partner like Claritev because, again, we want to look at this stuff holistically across carriers. It would take me four times as long to go into every health plan and do this kind of analysis.

    Executive Vice President

    Large, regional consulting firm/insurance brokerage

Explore resources designed to help government healthcare leaders navigate fraud prevention, regulatory complexity, transparency mandates, and funding pressure.

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  • 2021 brings changes to Medicare Advantage plans

    Given the many changes in 2021, Medicare Advantage plans and their members will need to adjust. These changes are positive for members—for health plans,…

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Let’s talk about how Claritev can help you reduce fraud, improve oversight, and demonstrate measurable program effectiveness.