ClarisHealth Launches A.I. Powered Healthcare Fraud Detection Solution for Health Plans

ClarisHealth Launches A.I. Powered Healthcare Fraud Detection Solution for Health Plans

NASHVILLE, TENN. (PRWEB) SEPTEMBER 09, 2020 – – ClarisHealth, the company transforming health plan operations with its comprehensive payment integrity technology platform Pareo®, launched today an artificial intelligence-based (A.I.) solution for healthcare fraud detection. Pareo Fraud Detection works seamlessly with Pareo Fraud Case Management for an integrated, 360-degree approach to mitigating fraud, waste and abuse (FWA).

According to Mark Isbitts, Vice President of Program Integrity for ClarisHealth, who led the project, Pareo Fraud Detection provides significant advantages over conventional tools that have been in use for decades. This traditional approach involves sifting through massive amounts of data and defining thousands of rules to detect fraud, which limits its scope of effectiveness.

“Currently, the SIU deals with overwhelming numbers of false positives and manual processes and still may miss some aspects of fraudulent activity and new emerging criminal schemes,” says Isbitts. “Pareo Fraud Detection is based on our proven payment integrity technology platform and features a transparent and efficient user interface that provides a view of why a provider is marked as fraud and enables investigators to visualize different patterns and scenarios in just a few clicks – without inputting multiple rules. ”

Pareo Fraud Detection models were developed in partnership with data science experts from the College of Business Administration at the University of Illinois-Chicago (UIC). Kyle Cheek, PhD., the Director of the Center for Applied Analytics and a clinical associate professor of Information and Decision Sciences at the university, has worked in various payer fraud organizations. He helped ensure the solution escaped a fundamental drawback of A.I.: lack of explainability.

“An A.I.-based technique is not usually transparent about how it generates its outputs and is often referred to as the ‘black box,’” says Cheek. “However, Pareo Fraud Detection harnesses the power of deep learning applications of A.I. informed by domain expertise so the SIU will get information on which providers to investigate first, why a provider is suspicious, and how valuable the investigation can be – in real-time, efficiently, and with limited manual efforts.”

The release of Pareo Fraud Detection continues the ClarisHealth strategic direction of expanding the native functionality of the Pareo platform to maximize health plan cost avoidance and recoveries at the most optimized cost. According to ClarisHealth CEO Jeff McNeese, this approach is termed Total Payment Integrity™ and it transforms engagement with internal and external stakeholders.

“Just like there had been little innovation in payment integrity before Pareo, the same has been true for FWA solutions,” says McNeese. “Being able to solve payment integrity and FWA challenges end-to-end – from prepay to post-pay – on a single platform fulfills the Total Payment Integrity promise of Pareo.”

About ClarisHealth

ClarisHealth is the answer to the health plan industry’s siloed solutions and traditional models for identification and overpayment recovery services. ClarisHealth provides health plans and payers with total visibility into payment integrity operations through its proprietary advanced cost containment technology platform Pareo®. Pareo enables health plans to maximize avoidance and recoveries at the most optimized cost for a 10x return on their software investment. For more information please visit  https://www.clarishealth.com.

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Source: ClarisHealth

ClarisHealth Ranks No. 8 Among Tennessee Software Companies on the 2020 Inc. 5000

ClarisHealth Ranks No. 8 Among Tennessee Software Companies on the 2020 Inc. 5000

Inc. Magazine Unveils Its Annual List of America’s Fastest-Growing Private Companies—the Inc. 5000 

NEW YORK and NASHVILLE, Tenn., August 13, 2020 – Inc. magazine today revealed that ClarisHealth is No8 among Tennessee software companies on its annual Inc. 5000 list, the most prestigious ranking of the nation’s fastest-growing private companies. The list represents a unique look at the most successful companies within the American economy’s most dynamic segment—its independent small businesses. IntuitZappos, Under Armour, Microsoft, Patagonia, and many other well-known names gained their first national exposure as honorees on the Inc. 5000. 

“The incredible growth of ClarisHealth has only begun, as represented by our first appearance on this list,” says Jeff McNeese, CEO of ClarisHealth. “The team’s laser focus on transforming engagement in healthcare and their commitment to our Got Your Back culture makes this accomplishment possible. 

Not only have the companies on the 2020 Inc. 5000 been very competitive within their markets, but the list as a whole shows staggering growth compared with prior lists as wellThe 2020 Inc. 5000 achieved an incredible three-year average growth of over 500 percent, and a median rate of 165 percent. The Inc. 5000’s aggregate revenue was $209 billion in 2019accounting for over 1 million jobs over the past three years.   

Complete results of the Inc. 5000, including company profiles and an interactive database that can be sorted by industry, region, and other criteria, can be found at www.inc.com/inc5000. The top 500 companies are also being featured in the September issue of Inc., available on newsstands August 12. 

The companies on this year’s Inc. 5000 come from nearly every realm of business,” says Inc. editor-in-chief Scott Omelianuk. “From health and software to media and hospitality, the 2020 list proves that no matter the sector, incredible growth is based on the foundations of tenacity and opportunism.” 

The annual Inc. 5000 event honoring the companies on the list will be held virtually from October 23 to 27, 2020. As always, speakers will include some of the greatest innovators and business leaders of our generation. 
 

About ClarisHealth 

ClarisHealth is the answer to the health plan industry’s siloed solutions and traditional models for identification and overpayment recovery services. ClarisHealth provides health plans and payers with total visibility into payment integrity operations through its proprietary advanced cost containment technology platform Pareo®. Pareo enables health plans to maximize avoidance and recoveries at the most optimized cost for a 10x return on their software investment. For more information please visit www.clarishealth.com. 

More about Inc. and the Inc. 5000 

Methodology 

The 2020 Inc. 5000 is ranked according to percentage revenue growth when comparing 2016 and 2019. To qualify, companies must have been founded and generating revenue by March 31, 2016. They had to be U.S.-based, privately held, for profit, and independent—not subsidiaries or divisions of other companies—as of December 31, 2019. (Since then, a number of companies on the list have gone public or been acquired.) The minimum revenue required for 2016 is $100,000; the minimum for 2019 is $2 million. As always, Inc. reserves the right to decline applicants for subjective reasons. Companies on the Inc. 500 are featured in Inc.’s September issue. They represent the top tier of the Inc. 5000, which can be found athttps://www.inc.com/inc5000. 

About Inc. Media 

The world’s most trusted business-media brand, Inc. offers entrepreneurs the knowledge, tools, connections, and community to build great companies. Its award-winning multiplatform content reaches more than 50 million people each month across a variety of channels including websites, newsletters, social media, podcasts, and print. Its prestigious Inc. 5000 list, produced every year since 1982, analyzes company data to recognize the fastest-growing privately held businesses in the United States. The global recognition that comes with inclusion in the 5000 gives the founders of the best businesses an opportunity to engage with an exclusive community of their peers, and the credibility that helps them drive sales and recruit talent. The associated Inc. 5000 Conference is part of a highly acclaimed portfolio of bespoke events produced by Inc. For more information, visit www.inc.com. For more information on the Inc. 5000 Conference, visit https://conference.inc.com/ 

Two Healthcare Technology Veterans Join ClarisHealth’s Board

Two Healthcare Technology Veterans Join ClarisHealth’s Board

Doug Ghertner and George Lazenby, IV, add significant expertise to the healthcare payer technology company’s board of directors

NASHVILLE, Tenn., Jan. 30, 2020 – ClarisHealth, the company transforming health plan operations with its comprehensive payment integrity technology platform Pareo®, today announced two additions to its Board of Directors. Doug Ghertner and George Lazenby, IV, both healthcare technology veterans, were approved unanimously.

Ghertner currently serves as the CEO of IVX Health, a national provider of infusion and injection therapy for individuals with chronic disease. He brings more than 20 years of healthcare experience to the Board, including senior leadership positions at CVS Health, Change Healthcare and Emdeon. As CEO of Change Healthcare, Ghertner oversaw its acquisition by Emdeon in 2014 and assumed the role of Executive Vice President and Chief Sales Officer through 2017.

Lazenby co-founded and serves as CEO of OrderInsite, a provider of tools and advanced analytics to manage and control prescription drug inventory. He has more than 20 years of healthcare IT experience, including CEO of Emdeon, the nation’s largest health information network. Lazenby led Emdeon through a successful IPO in 2009 and sale in 2011. He also serves as a board member for Concert Genetics, ProxsysRx and CarePayment. 

In just three years, ClarisHealth has grown Pareo to tens of millions of health plan members supported by the platform today through leading national and regional payer partnerships. Given the company’s strong market momentum, leadership expects to exceed 100 million members supported by Pareo over the next 18 months.

“ClarisHealth has experienced rapid adoption of our leading platform Pareo®, and it is important for us to routinely tap into thought leaders who will help us navigate the opportunities of a fast-growing business. Doug and George each bring a unique and incredibly valuable perspective to our Board of Directors, ” said Jeff McNeese, CEO of ClarisHealth. “We credit the leadership of our Board with the strategic success of ClarisHealth and look forward to seeing that grow in the coming years under the guidance of proven leaders in our industry.”

Mr. Ghertner and Mr. Lazenby join co-founders Darby Brown and Jim Sohr, who formed the company in 2013 to bring unique technology-enabled solutions to the payment integrity industry. ClarisHealth works with leading health plans across the country to drive significantly higher recovery performance while maximizing productivity.

About ClarisHealth

ClarisHealth is the answer to the health plan industry’s siloed solutions and traditional models for identification and overpayment recovery services. ClarisHealth provides health plans and payers with total visibility into payment integrity operations through its proprietary advanced cost containment technology platform Pareo®. Pareo® enables health plans to maximize avoidance and recoveries at the most optimized cost for a 10x return on their software investment. For more information please visit clarishealth.com

 

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ClarisHealth Hires Mark Lavallee as Chief Growth Officer

ClarisHealth Hires Mark Lavallee as Chief Growth Officer

Industry veteran will extend ClarisHealth’s strategic direction in accelerating adoption of market-leading technology solutions for health plans.

NASHVILLE, Tenn., Jan. 20, 2020 – ClarisHealth, the company transforming health plan operations with its comprehensive payment integrity technology platform Pareo®, hired Mark Lavallee as Chief Growth Officer. In this newly created role, Lavallee will lead the sales team in expanding ClarisHealth’s presence in the health plan market. 

Lavallee has over 30 years of sales and marketing experience, including 15 years in healthcare payment integrity and data analytics. He has led the strategic sales efforts for some of the leading providers of technology and services for health plans, growing those companies from early stage to market leaders.

Lavallee most recently served as Vice President and Head of Key Accounts at EXL, Senior Vice President of Sales at SCIO Health Analytics before their acquisition by EXL, and the Chief Marketing Officer at National Audit up until their acquisition by SCIO Health Analytics.

“We are thrilled to add Mark to our growing executive team,” said Jeff McNeese, CEO of ClarisHealth. “His industry expertise and track record with accelerating growth at early-stage companies promises to take our sales organization to the next level.”

“What ClarisHealth has developed is the most innovative solution I’ve seen in my 15 years in healthcare payment integrity. Pareo leverages technology to maximize medical savings and reduce administrative burden while introducing unprecedented transparency,” says Lavallee. “I very much look forward to helping ClarisHealth lead health plans forward in their journey towards transforming their payment integrity and fraud, waste and abuse processes.”

Lavallee began his career in sales and marketing in 1986 when he joined General Motors Corporation as a cooperative education student, and since then, he has held numerous senior sales and marketing positions within Fortune 200 and other large organizations such as American Honda Motor Company and Automatic Data Processing (ADP). He received a Bachelor’s Degree at GMI Engineering & Management, now called Kettering University, in Flint, Mich. He lives in the greater Miami area with his family.

 

About ClarisHealth

ClarisHealth is the answer to the health plan industry’s siloed solutions and traditional models for identification and overpayment recovery services. ClarisHealth provides health plans and payers with total visibility into payment integrity operations through its proprietary advanced cost containment technology platform Pareo®. Pareo®enables health plans to maximize avoidance and recoveries at the most optimized cost for a 10x return on their software investment. For more information please visit clarishealth.com

For press inquiries, please contact us here.

Press Release: Leading Payment Integrity Technology Company Launches New Solution to Combat FWA

Press Release: Leading Payment Integrity Technology Company Launches New Solution to Combat FWA

ClarisHealth VP of Program Integrity Mark Isbitts envisions a “better way” to FWA management, announces release of Pareo Fraud at 2019 NHCAA Conference

NASHVILLE, Tenn., October 21, 2019 – At the annual NHCAA Anti-Fraud Training Conference in Nashville last week, ClarisHealth’s Vice President of Program Integrity, Mark Isbitts, announced a new technology product for the company. The new product line is known as Pareo Fraud, and the Nashville-based company will be partnering with its customers on the market rollout of the initial release. 

“There’s truly nothing else like it on the market,” says Isbitts, a 25-year healthcare veteran. “At least 10-percent of healthcare claims are paid inaccurately, and Pareo Fraud can help health plans reduce fraud, waste and abuse losses by 40-percent in the first year.”

Isbitts has worked for some of the leading healthcare payment integrity vendors, where he was responsible for launching new products into the market. “This solution will enable health plans to aggressively and comprehensively tackle FWA through advanced and integrative technologies, and facilitating root cause analysis between the SIU and other payment integrity disciplines such as Coordination of Benefits (COB), Provider Bill Audit and Data Mining.” 

This holistically-minded approach to payment integrity technology, touted as Total Payment Integrity™ by the company, is a natural and in many ways client-demanded next step for ClarisHealth, creators of Pareo. “We went to market five years ago with Pareo, and the solution we’ve created has been so successful, our clients are asking us to apply those concepts to other lines of  business,” says ClarisHealth CEO Jeff McNeese. 

The product will roll out in phases, with a case management solution being the initial offering. Isbitts says the impact of Pareo Fraud could be “major” in an industry that still relies on old and outdated technology to combat increasingly sophisticated fraud, waste and abuse schemes. 

“We’ve talked to many health plans that feel limited by the technology solutions that are currently available, some of which have been used for 30 years. We feel confident that we can leverage the success of Pareo, coupled with advanced analytics and artificial intelligence, and apply that same experience to the FWA market,” says Isbitts. 

Last Tuesday, during the Welcome Reception in NHCAA’s Anti-Fraud Expo hall, attendees were abuzz at the implications of such a solution. “It’s exciting to sit in front of health plan leaders and introduce a solution to a decades-old problem,” says Isbitts, who made the product announcement official during one of the show’s Fraud Side Chat presentations.  

For future and current Pareo clients, some of whom hope to adopt Pareo Fraud in the coming year, the value is clear, according to Jason Medlin, VP of Marketing for ClarisHealth.

 “We’ve met with health plan leaders who are asking us to solve the problem of siloed fraud, waste and abuse efforts. This market is ready to move away from outdated methods and for the first time, they’ll have a robust and integrated technology solution to truly manage the growing demands on SIU departments,” commented Medlin.

Mark Isbitts, VP of Program Integrity

Pareo Fraud will seamlessly integrate with the Pareo suite of solutions to offer health plans an aggressive and powerful platform to combat fraud, waste and abuse, while also remaining easy to implement. To learn more about this new technology solution, contact Mark Isbitts directly at misbitts@clarishealth.com

 

About ClarisHealth

ClarisHealth is the answer to the health plan industry’s siloed solutions and traditional models for identification and overpayment recovery services. We provide health plans and payers with total visibility into payment integrity operations through our advanced cost containment technology Pareo®. Pareo®enables health plans to maximize avoidance and recoveries at the most optimized cost for a 10x return on their software investment. For more information please visit us at clarishealth.com

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ClarisHealth Hires Mark Isbitts as Vice President of Program Integrity

ClarisHealth Hires Mark Isbitts as Vice President of Program Integrity

25-year industry veteran will extend ClarisHealth’s strategic direction in growing and building market-leading technology solutions for health plans.

NASHVILLE, Tenn., July 2, 2019 – ClarisHealth, a leading provider of advanced payment integrity technology for health plans, hired Mark Isbitts as Vice President of Program Integrity. Isbitts will  create and launch new products, increase market awareness, position products and cultivate market opportunities.

Isbitts brings with him over 25 years experience in healthcare, including 15 years in product management leadership. He has worked for some of the leading healthcare Payment Integrity vendors where he launched several new products into the market. 

In his roles immediately prior to joining ClarisHealth, Isbitts helped several mid- to large clients in the healthcare payer technology space with their product management and ideation processes, go to market strategy and overall positioning, and led a team that managed a product portfolio of over $155 million.

“We’re very excited to have Mark on board,” says Jeff McNeese, CEO of ClarisHealth. “His depth of experience, knowledge and product management capabilities will complement our growing team of seasoned executives and help us deliver on new products and solutions to our expanding base of health plan clients.”

Isbitts holds a B.S. from the University of Michigan and a Master’s in Healthcare Administration from Mercer University. He lives in the greater Atlanta area with his family.

“ClarisHealth is on the forefront of technology-enabled payment integrity and FWA solutions,” says Isbitts. “In many respects, the company is charting a new course for how these services have historically been delivered. I very much look forward to helping ClarisHealth deliver one-of-a-kind solutions that help health plans maximize medical savings most cost effectively.”

About ClarisHealth

ClarisHealth is the answer to the health plan industry’s siloed solutions and traditional models for identification and overpayment recovery services. We provide health plans and payers with total visibility into payment integrity operations through our advanced cost containment technology Pareo®. Pareo®enables health plans to maximize avoidance and recoveries at the most optimized cost for a 10x return on their software investment. For more information please contact us via the button below.