What we do Client outcomes
Identify:

  • Compliance Risks
    • Regulatory
    • Contract Service Level Agreements (SLAs) and Performance Guarantees (PFGs)
    • Data Exchange Gaps and Remediation efforts

Implement:

  • Reconciliation tools to reduce the risk of Data Discrepancies
    • Eligibility
    • Provider
    • Claims Payment
    • Encounters
  • Audit Universe Validation
  • Payment Integrity & Program Validation Tools
Proven results:

  • Empower our clients to control costs
  • Reduce risks to ensure effective service delivery
  • Improved Program outcomes, Managed Oversight and Quality Controls
    • Compliance and Data Exchange Integrity
    • Member and Provider Network satisfaction
    • Claims payment accuracy and timeliness
    • Appeals and Grievances accuracy and timeliness
    • Plan Payments and accurate Risk Adjustment Factor Scores (RAF)
  • Increased Audit Universe Data Integrity
  • Improved Fraud, Waste and Abuse Detection