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HEALTH PLANS

Improve Payment Accuracy. Strengthen Financial Performance.

Health plans face increasing pressure to manage medical costs, improve payment accuracy, and operate more efficiently. Claritev combines healthcare insights, advanced analytics, and technology-enabled solutions to help health plans identify savings opportunities, streamline operations, and make more informed decisions.

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Greater visibility. More confident decisions.

Rising medical costs, payment complexity, regulatory pressures, and fragmented systems make it increasingly difficult for health plans to manage performance and demonstrate results.

Claritev helps health plans address these challenges with connected payment integrity, network, reimbursement, and analytics solutions. By combining healthcare intelligence with technology and experienced support, we help organizations identify opportunities, improve operational efficiency, and strengthen financial oversight.

Improve accuracy. Increase efficiency. Strengthen performance.

Improve payment accuracy.

Improve payment accuracy and identify cost-saving opportunities with data-driven payment integrity solutions that help prevent overpayments, recover funds, and protect financial performance.

Manage healthcare costs.

Gain visibility into spending and reimbursement opportunities to support more informed cost-management strategies.

Streamline operations.

Reduce manual processes and administrative complexity with technology-enabled solutions that support faster, more efficient operations.

Make more informed decisions.

Apply healthcare analytics and market intelligence to evaluate opportunities, manage risk, and guide strategic planning.

Solutions built for stronger health plan performance.

Claritev helps health plans make more informed decisions through trusted data, advanced analytics, and healthcare expertise.

Payment & Revenue Integrity

Payment and Revenue Integrity Solutions

Increased waste and inaccurate payments continue to drive up health expenditures. We aim to bring clarity to the process by driving accuracy before, during, and after a claim, helping to reduce waste and abuse across the healthcare ecosystem.

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Network Performance

Network Solutions

Network strategy is foundational for sustainable financial performance. We help health plans gain greater flexibility and control over reimbursement and access, enabling more confident medical spend management and cost control.

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Claims Optimization

Claims Intelligence Solutions

Escalating costs and surprise bills put pressure on both plans and members. Our Claims Intelligence Solutions aim to clarify the complexity with expert negotiation, reference-based pricing solutions, and surprise billing solutions that help support fair reimbursement for healthcare services and preserve member access and experience. 

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Analytics & Decision Support

Data and Analytics Solutions

Health plans need clarity and confidence in their data. When pricing and cost dynamics are clear, health plans can act decisively, govern their operations more strategically, and manage trends with greater predictability to drive smarter strategies and long-term performance. 

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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.

  • 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

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

    Dominic Marzolino, National Analytic Consultant

    Insurance Office of America

Medicare Advantage Network Expansion Strategy

A practical guide to disciplined Medicare Advantage network expansion.

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Explore insights driving smarter health plan decisions.

Explore research, insights, and expert perspectives designed to help health plans improve payment accuracy, manage healthcare costs, navigate regulatory complexity, and make more informed decisions in a rapidly evolving healthcare landscape.

  • Medicare Advantage Expansion Strategy White Paper

    Medicare Advantage Expansion Strategy

    Explore a practical framework for evaluating Medicare Advantage expansion opportunities, assessing network feasibility, and making more informed go/no-go decisions.

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  • document with chart pointing to palm holding checkmark and X, blue background

    Turning Transparency Data Chaos into Reimbursement Intelligence

    Transparency data is transforming reimbursement strategy, but only when it can be trusted and applied effectively. Discover how Claritev turns complex pricing data into…

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  • Rethinking Reference-Based Pricing

    Rethinking Reference-Based Pricing

    Reference-based pricing is evolving to meet the demands of rising healthcare costs, shifting market conditions and changing business priorities. This white paper explores how…

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Let’s talk about your health plan priorities.

From payment accuracy and cost management to operational efficiency and reimbursement strategy, explore how Claritev can help address your organization’s challenges.