Government

Mission-enabling solutions that aim to strengthen program integrity, expand access to high-quality care, improve transparency, and protect long-term sustainability.

Helping Clients Serve More Beneficiaries Under Greater Scrutiny.

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.

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Featured Solutions

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).

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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.

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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.

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Explore Our Solutions

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.

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U.S. Department of Veterans Affairs (VA)

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

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Defense Health Agency (DHA)

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

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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
They (Claritev) are continuously refining and developing the platform to meet my needs.

A Major Healthcare Provider
The Technology Leadership Program has brought my department tremendous value. The well-structured program offers the talented hardworking associates options for their career paths, yet exposes them to high visibility initiatives. Every associate has brought a unique perspective and strong professional skills to the organization.

Bobby Vincent

Senior Information Technology Director
The Technology Leadership Program associates have a tremendous opportunity before them. To have three years to rotate through various departments within Information Technology before deciding which role/area suits them best.  Depending on their choice and interest, they become a unique blend of technologist, business expert and, eventually, corporate leader.

Andrew George

Senior Vice President, Information Technology
One of the great successes of the program has been our ability to identify and develop emerging leaders whom contribute in every facet of our business. It hasn’t been just about growing IT leaders, it’s about maturing business leaders for Claritev.

Ed Ververs

Senior Director, Telecom & Data Center Management
I had the privilege to mentor some of the Technology Leadership Program participants and was fortunate to absorb a member into my team, where he has helped tremendously with new automation techniques. Participants bring in fresh perspectives and extreme enthusiasm to IT here at Claritev. I’m looking forward to adding more.

Vasu Raghunathan

Senior Director of Data & Service Delivery
You have been a great partner from day one. You collaborate with us until we find a resolution. We look forward to a long-standing partnership.

Payment Integrity and Performance Manager
The things we value most about our partnership with Claritev are not just the reliable, efficient delivery of savings through their MSP and ESRD services, but the fact that they are always willing to come to the table to discuss and collaborate on new and innovative solutions that nobody else in the industry has yet to try.

Drew Satriano, VP of Payment Integrity

Highmark, Inc.
In our experience, Claritev has been very responsive with great turnaround times and the findings they’ve presented to SIHO have been accurate and reasonable.

Claims Department

SIHO Insurance Services, Inc.

Clear Insight. Measurable Impact.

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

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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A Single-Vendor Approach May Improve Your Payment Integrity Program

A Single-Vendor Approach May Improve Your Payment Integrity Program Brad Ross Senior Vice President, General Manager Payment & Revenue Integrity, Claritev In 2024, spending…
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Q&A with Kinetiq Health’s Chief Clinical Officer

Sarah Michaels, Chief Clinical Officer of Kinetiq Health, makes the opportunity clear: healthcare can use data to make decisions that lead to better outcomes…
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