Medicare Advantage
Greater Payment Accuracy. Stronger Networks. Better Financial Performance.
As Medicare Advantage enrollment grows, health plans must navigate increasing claim complexity, evolving regulations, and ongoing cost pressures. Claritev helps plans meet these challenges through integrated network and payment integrity solutions that improve payment accuracy, strengthen provider access, and help drive healthcare affordability.
Together, these solutions help Medicare Advantage organizations reduce wasteful spending, optimize provider relationships, and improve operational efficiency.
Helping Support Star Ratings Performance
Strong provider networks and efficient payment operations play an important role in the member and provider experience. Claritev helps Medicare Advantage plans improve access to care, reduce provider administrative burden, and promote payment accuracy, supporting the operational excellence and member experience that contribute to quality and Star Ratings performance.
25+
Medicare Advantage clients
90%
Retention rate for Medicare
Advantage clients
16
Years of Medicare Advantage experience
Access Backed by Extensive Provider Networks
Claritev owns and manages networks with more than 1.4 million participating providers, helping Medicare Advantage plans expand access, support member satisfaction, and manage costs through trusted provider relationships.
Our Solutions
By addressing payment inaccuracies across the claims lifecycle, plans can better manage medical costs.
Network Solutions
A strong network is critical to delivering value for members and controlling healthcare costs. Claritev helps Medicare Advantage plans:
- Expand access to quality providers
- Enhance network performance
- Manage out-of-network costs
- Improve provider engagement
- Improve payment accuracy through claims repricing
- Streamline administration with integrated client-contracted provider fee schedules
Payment Integrity Solutions
Accurate payments can support healthcare affordability and operational efficiency. Claritev helps Medicare Advantage plans:
- Identify claim inaccuracies before payment
- Validate coding and reimbursement methodologies
- Review complex facility and inpatient claims
- Recover inappropriate payments
- Improve coordination of benefits and subrogation outcomes
- Protect premium revenue through the Medicare Secondary Payer Validation and End-Stage Renal Disease Premium Restoration
Supporting Medicare Advantage Success
From network optimization to payment integrity, Claritev combines deep healthcare expertise, AI-enabled technology, and decades of experience to help Medicare Advantage plans navigate complex reimbursement and network challenges.
Our solutions help Medicare Advantage plans:
Promote payment accuracy
Identify savings opportunities
Improve operational efficiency
Strengthen provider relationships
Expand access to care
Support long-term affordability goals
Explore Solutions Built for Medicare Advantage Success
Learn how health plans leverage our capabilities to support greater accuracy, reduce administrative burden, and help drive better outcomes.