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GOVERNMENT

Help Strengthen Program Performance

Government healthcare agencies face increasing pressure to contain costs, improve transparency, and protect public resources. Claritev provides the data, analytics, and expertise needed to help strengthen program integrity, improve payment accuracy and operational efficiency, and deliver better outcomes.

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Accountability to help improve program performance.

Government healthcare agencies face increasing pressure to contain costs, reduce improper payments, including those resulting from fraud, waste, and abuse, and demonstrate responsible stewardship of public resources. At the same time, evolving regulations, changing healthcare markets, and growing transparency requirements make it more challenging to balance fiscal responsibility with quality outcomes.

Claritev can help government healthcare organizations strengthen oversight, improve program integrity, and optimize healthcare spending through connected data, advanced analytics, and healthcare expertise designed to enable more accurate, informed decisions and better program outcomes.

Help strengthen oversight and improve outcomes.

Help strengthen program integrity.

Identify improper payments, address their root causes, reduce fraud, waste, and abuse, and help improve accountability with trusted data, analytics, and payment integrity solutions.

Help improve financial stewardship.

Gain greater control over healthcare spending with insights that help identify savings opportunities and optimize resource allocation.

Help increase transparency.

Access connected healthcare data and market intelligence to support informed decision-making, reporting requirements, and greater accountability.

Help enhance program performance.

Enable improved operational efficiency, support regulatory compliance, help reduce unnecessary administrative burden, and make informed decisions that can enhance program effectiveness and beneficiary outcomes.

Solutions that help support strong oversight and positive outcomes.

From payment integrity and network optimization to healthcare analytics and decision support, Claritev can help government healthcare organizations strengthen oversight, maximize public resources, and deliver better program outcomes.

Program Integrity & Payment Accuracy

Advanced Code Editing

Identify coding inconsistencies and potential billing errors through intelligent automation and expert clinical review to help improve claims accuracy, reduce improper payments, and support more accurate payment decisions and program integrity.

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Coordination of Benefits

Validate proper payer responsibility and help prevent duplicate or inaccurate payments by identifying coverage overlaps and coordinating benefits across claims.

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Network Performance & Cost Management

Network Solutions

Access a national PPO network with integrated payment integrity capabilities that help control costs, support beneficiary access, and maximize the value of healthcare resources without compromising quality.

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Transparency & Decision Support

BenInsights® Performance Intelligence

Leverage advanced healthcare analytics and actionable insights to help increase transparency, support oversight, identify savings opportunities, and make more informed decisions.

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  • 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.

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

    Manager

    Large Midwest health plan

  • 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

  • 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

  • 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

  • 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

  • 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

A Smart Approach to Payment Integrity

Discover how a proactive approach to payment integrity can help prevent improper payments, reduce administrative burden, and strengthen financial stewardship.

Read the Article

Stay ahead of the healthcare challenges impacting public programs.

Explore research, guides, and expert perspectives designed to help government healthcare organizations strengthen program integrity, improve transparency, optimize healthcare spending, and drive better outcomes.

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Ready to advance accountability and performance?

Discover how Claritev can help your organization improve program integrity, increase transparency, optimize healthcare spending, and achieve positive outcomes through connected data, advanced analytics, and tested healthcare solutions.