Proactive Claims Payment Integrity

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Pre Pay Clinical Reviews

The Pre-pay Modules in our platform flag and pause suspect claims in real-time, requesting medical records from providers for a thorough review. This system is ideal for placing specific providers under pre-pay review following a post-payment fraud investigation or for scrutinizing certain claim or service types. Our clinical review team assesses claims for coding and clinical issues, determining the appropriate action – denial, adjustment, or original billing.

Identify and Resolve Fraud, Waste, or Abuse Before it Happens

Team of experts

Clinical Auditors RN, LPN Licensed medical review experts

Coding Auditors CCS, CIC, CPC Certified coding review experts

Quickly identified and confirmed fraud and payment issues.”

Market focus

Whether you’re a health plan / payer, regulator or investigator, we provide you with seamless analytics solutions that ensure healthcare payment accuracy swiftly and effectively.

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Want to see how you can finally achieve healthcare payment integrity?

Experience a demo of our purpose-built platform.