Checking in: How to offer vendors a concierge experience

Checking in: How to offer vendors a concierge experience

When we created Pareo®, from its inception we knew vendors would be an important stakeholder in the payment integrity ecosystem. As our payment integrity solution has grown (in many ways, shaped by our incredible clients), it has cemented our belief that focusing on payment integrity suppliers is an important way we can better meet the needs of modern health plans. 

As you likely know, including more vendors in your payment integrity operations is likely to boost your recoveries. Yet, managing relationships with them can feel burdensome when we don’t have access to the right tools or information. That’s why we’ve set out to give those suppliers working with Pareo what I like to call the “Ritz Carlton experience.” 

That’s because — as with every relationship — you get from your vendors what you put in. We want to enable our clients to give their suppliers a five-star experience when working together. We developed Pareo Supplier Optimization to give your PI department all the tools they need to work effectively with vendors by boosting transparency, increasing engagement rates and contributing to improved recoveries. Perhaps you’ve discovered for yourself the value Pareo brings but you’re still looking for other ways to increase vendor experience. If so, read on.

Request a brochure and learn more about Pareo’s Supplier Optimization functionality.

7 Ways to Treat Your Vendors as Well as Customers

So much focus has been given to improving member satisfaction at health plans (with good reason — it’s important). But your vendors are such an important part of health plan operations, why not focus on their satisfaction as well? Are you giving them everything they need to help you maximize your return on investment? 

As you look to technology to improve supplier relationships, be sure to cover all your bases by striving for these 7 important functions that can lead to a better vendor relationship:

1. Share goals. The most successful vendor relationships function more like partnerships, rather than transactions. You both have the potential to provide greater value to the other.


“Vendor management is not negotiating the lowest price possible but constantly working with your vendors to come to agreements that will mutually benefit both companies.”



2. Communicate clearly and consistently. Transparency allows everyone to be on the same page. Both sides should be able to easily provide access to information on project progress — without asking for silo-ed status updates. “There may be issues between you and your vendor, but constant communication and a dedication to continuous improvement will make the difference,” writes Brian Fielkow.


3. Plan ahead. Set expectations on service level agreements, contract terms, etc. Surprises and emergencies are inevitable, but should be the exception with a well-thought out vendor plan. 


4. Pay on time. Their invoice should never be a surprise. Paying in a timely manner communicates to vendors that their work is valued.


5. Provide process training for your vendors. They have their area of expertise, which likely does not include “how you do things.” Set them up for success by bringing them to the table.


6. Be reasonable and accountable. Vendors are third-party stakeholders that rely on you in order to perform at their best. Likewise, you rely on them to meet their goals. Respect is a key part of the vendor-payer relationship and for health plans, that means being reasonable and accountable in vendor relations.


7. Make the most of meetings. The quarterly business updates that characterize most third-party payment integrity vendor relationships can be more valuable than out-of-date “status updates.” They can be meaningful strategy sessions, if the day-to-day communications are taken care of.

Talk to ClarisHealth about how Pareo®advanced payment integrity technology is helping health plans successfully implement their digital-first strategies.

Prepare to Meet the Future with Data

Prepare to Meet the Future with Data

We revisit ONC’s Information Blocking Rule, recap public comments, and look at how health plans can meet data sharing  requirements.

Earlier this year, we wrote about the ONC’s proposed information blocking rule and how it serves as an opportunity for health plans. The proposed rule faced a public comment period (which closed last month) during which major industry concerns were voiced. The consensus by many seems to be that ONC’s rule lacks clarification in key areas while inadvertently increasing complexity (and cost) in others.  

But as they say, “the writing’s on the wall” for health data interoperability and broader access to electronic health information. Where does this leave health plans? A recent study by Deloitte predicts that healthcare organizations are standing at the precipice of innovation. But first, let’s look at the feedback that the proposed information blocking rule received.

Industry Response to the Information Blocking Rule

One thing we can agree on at this point: interoperability is a major objective for our industry. But those who would be affected by the Information Blocking Rule have asked the ONC to revise or even revoke the current rule. This includes the Federal Trade Commission, who despite being consulted on the proposed rule, issued a letter asking the ONC to consider refinements. Notably, eHealth Initiative (eHI) offered the following comments and concerns

Scope of “Electronic Health Information” is too broad, should be defined

Conditions and Maintenance of Certification (APIs)

      • Too complex and costly as proposed
      • Too much risk to providers and patients, specifically the proposed “Click Yes to Continue” model does not adequately portray data security risk to patient

Information Blocking

      • Healthcare actors should be defined in the final rule
      • Complex and costly documentation requirements

Greater Data Sharing is the Goal

The ONC has stated that greater interoperability is the goal of the proposed Information Blocking Rule. Improved data sharing is a worthy objective for health plans because it’s an easy effort to prove value on. Health plans have a competitive edge over their counterparts when they are more integrated with providers and members. In addition to priming plans to be compliant with whatever final rule is based, improving access to data is also key to readying for other initiatives, such as alternative payment models

Of course, we know that total healthcare data interoperability sounds like the answer to all your challenges. But once the hard work begins of solving this problem, it can feel like data sharing at the level required is next to impossible. We’re here to tell you it’s not; interoperability is a realistic goal with the right technology

Let’s frame the objective of the ONC’s Information Blocking Rule in a more approachable way: Healthcare stakeholders need real-time, accurate and contextual data access. And the real challenges? Healthcare organizations still struggle with interoperability, largely due to issues like administrative complexity. Messy (as in, unstructured) or missing data is still a problem as well. 

We know that our industry is on the precipice of innovation. The recent study from Deloitte referenced above and in our prior article posits healthcare is on the precipice of a “20 to 30 year industry transformation. The industry forces and the disruption that’s upon us are true indicators that we’re going to be going through a cycle of innovation.” Innovation made possible by radical data interoperability. 

ONC’s Information Blocking Rule has 7 exceptions. Do you know what they are?

See the official list here.

The Promise of Big Data

Improved access to data is considered a consumer-driven shift, one often compared to the Amazon experience where a consumer can have on-demand access to personal information. But getting personalized, real-time electronic health data at the click of a button is a lot more complicated than it sounds. And it requires a special relationship that has historically been difficult: high-level collaboration between payers and providers. 

Yet this demand is exactly the kind of opportunity health plans can seize upon as they search out competitive ways to utilize big data. Examples can be seen in the use of predictive analytics to mitigate risk, noted in this article as a “massive moneysaver” by one health plan who made a big IT investment. Reams of data are available to health plans — all that’s lacking is the right way to connect and analyze it. 

“Improving relationships with members and providers is already a focus for health plans, and data sharing is another way to accomplish that goal.”

Health plan of the future? It starts with data sharing.

One way of looking at the Information Blocking Rule is that it’s a proposed answer to a problem that health plans can take control of now. Improving data sharing isn’t just a proactive approach to anticipated regulation — it’s becoming an essential business function for health plans. To get started, health plans can focus on these three areas: 

Develop data analytics and predictive modeling know-how

Take advantage of opportunities to break down data silos by fostering relationships with providers, members and vendors

Look for existing technology that can support these goals: bring disparate data together, simplify data modeling, and provide a transparent communications platform

The future of data sharing is now. Pareo® is how.

Talk to ClarisHealth about how Pareo advanced payment integrity technology is helping health plans successfully implement their digital-first strategies. 

What makes value-based care programs work? 3 keys to success

What makes value-based care programs work? 3 keys to success

Following up on our previous article, we look more closely at what successful value-based care initiatives have in common.

It’s not all that surprising that one of our recent blog posts, Medicare for All: Should it be feared by health plans? has quickly become one of our most popular. Value-based care programs, like what the federal government has switched to, are at the forefront of discussions regarding the future of healthcare. And a recent survey indicates that providers are actually willing to take on more risk under alternative payment models, which signals well for value-based care adoption. 

But it takes awhile to implement value-based care programs and that may leave many health plans wondering what they can do to be proactive. Here are 3 strategic initiatives your health plan can pursue today to ensure value-based care programs will be successful on down the road. 

1. Communication

We’ve talked a lot lately on the blog about communication and collaboration and with good reason: the future of healthcare demands it. As care models shift, the need to work effectively with other vested parties is paramount. 

Take for example a recent panel in which industry experts (18 in all) were asked to define the term “value-based care.” While the term “value-based payment” was broadly agreed on, experts could not come to a consensus on the meaning of value-based care reports FierceHealthcare. “In addition to these specific gaps in communication, the study highlighted just how valuable it can be for industry leaders to convene with others who may not share the same perspective,” says Meredith Williams, M.D.

Health plans can prepare for  value-based care by fostering better communication with internal and external stakeholders. As Williams points out above, sitting down with other experts in the industry to get on the same page is a powerful — and unprecedented — move. 

2. Transparency

Alongside value-based care runs another initiative: transparency. Real-time access to crucial medical details, patient access to data, and upfront pricing are goals associated with successful value-based care programs. 

True transparency is only possible when health organizations have a firm grasp on data. Yet interoperability remains a struggle: 74% of respondents in this survey list the “ability to aggregate and share information as an extremely important need over the next three years.” By 2020, 59% of healthcare payments will be from value-based care models, and that means health plans need to work now on integrative data strategies. 

A shift towards transparent practices can directly affect your health plan’s relationship with providers. The ability to collaborate with elements of the healthcare trifecta (patient, provider and payer) will grow increasingly important for health plans seeking to thrive in a value-based care environment. “If value-based care is about aligning what works best for the patient to a hospital’s financial incentives, then insurers and providers must work together to create the best outcomes,” writes Healthcare Finance

3. Technology

With communication and transparency as actionable goals for health plans seeking to prepare for value-based care, technology is a third and crucial piece of the puzzle. With the right technology solution, health plans can improve communication and engagement with key stakeholders while promoting more transparent data practices. “Data is much easier to connect with when you are able to see it in real-time,” notes Jason Medlin, ClarisHealth VP of Marketing & Business Development. 

Investing in IT and technology to foster innovation was a featured conclusion of the Deloitte report “The Health Plan of Tomorrow.” Switching from volume to value in healthcare models will require a sophisticated technology strategy. The goals of value-based care programs — largely focused on access to patient care data — are not currently achievable at many health plans. 

The fastest way to transform? Technology, says Healthcare Finance. A comprehensive payment integrity solution should also provide a way of interpreting big data to transfer into actionable insights. “Once an organization has its data and is able to analyze it, it can then pinpoint opportunities for changing the practice to improve efficiencies without compromising quality outcomes — and for improving patient care overall.”

The Healthcare Trifecta Matters More Than Ever

Payers, providers and patients make up what we refer to as the “healthcare trifecta,” and the effectiveness of this relationship directly correlates with the success of value-based care models. Even as payers and providers work towards improved collaboration and communication, health plan members also  seek more ready access to information. Health plans who focus on supporting and improving their relationships with providers and patients are poised to adopt value-based care more successfully.

Talk to ClarisHealth about how Pareo®advanced payment integrity technology is helping health plans successfully implement their digital-first strategies. 

Should You Build Your Own Supplier Management Solution?

Should You Build Your Own Supplier Management Solution?

Take our quiz to help you decide if build or buy is right for your health plan. 

By now, you likely realize that your health plan needs a way to manage the many third-party vendors that allow you to maximize recoveries and optimize costs. The question is, should you build a solution internally or buy one?

We routinely run across health plan stakeholders in the midst of customizing their claims editor and other resource-intensive but relatively manageable IT projects. Most recently, we encountered a health plan considering building their own vendor management solution. That they need a solution is understandable. That they plan to build it themselves begs the question, “Are you a health insurance provider or a technology company?”

You know building your own software is going to cost more than you budgeted for, your IT resources are already constrained, and your expertise may be limited. But if your needs are truly unique, why look for a flexible, robust technology solution created with the support of industry-wide insight when you could devote millions of dollars to a solution of your very own?

In all seriousness, building a software solution with the ability to plug into dozens of independently-operated platforms (as in the case of third-party vendors) requires some heavy lifting. Are you ready? Let’s find out!

Should You Build or Buy a Vendor Management Solution? The Quiz

To take this quiz, view the following slideshow and record your answers. 




Perhaps you’ve already tried to build your own IT solution, and it didn’t go anywhere. Or maybe you’re on the fence about building something that’s already on the market. However, you aren’t sure if what’s out there is really what you need. Not all vendor management solutions are the same, and we’ve learned that our clients appreciate the customization opportunities that Pareo® offers. In fact, we offer the ability for health insurance providers to completely outsource vendor management to us.

Because you’ve likely tried to build a software solution before, you may face internal pressure to just “make it work.” Here’s a helpful guide that discusses what it takes to successfully develop software (hint: It’s not simple). Borrow a page from tech company playbooks and take a realistic approach to any internal software development efforts.

You may – or may not – be able to successfully build your own vendor management solution. But it’s important to ask if IT development is really your true calling. Most health insurance providers we speak with develop internal software solutions as a means to an end. They quickly realize that the upkeep and maintenance associated with these insular solutions is not manageable. That’s because building an internal IT solution isn’t the same as buying one from a company whose sole focus is solving the types of challenges your health insurance company faces.

“Technology alone delivers no value. It’s the combination of a clear strategy, the right technology, high-quality data, appropriate skills, and lean processes that adds up to create value. Any weak link in this chain will lead to poor value delivery from IT,” writes McKinsey. As you evaluate whether or not to build or buy your own vendor management solution, consider all the elements at play. Technology alone isn’t enough; to be successful, you’ll need a force behind your internal IT development.

You are the healthcare insurance unicorn – an IT-heavy, resource-laden organization that really can build your own internal software. We would ask you though, why reinvent the wheel? If a great vendor management solution does exist, and can be customized, why not tackle a software development project for which there isn’t already an answer?

“Building custom software can unlock a host of benefits, but companies should only pursue that strategy if a) better software can provide a competitive advantage relative to your competitors, and b) you are building a large business that can spread the cost of a proprietary system over a large number of clients,” writes one Forbes contributor with experience on the matter.

Taking on a software development project like this may derail your small IT resources, who would be better focused on their core competencies. We suggest exploring solutions that are already built and extremely customizable, like Pareo®. Not only do we offer the technology you need to manage multiple third-party vendors, but we also walk small health insurance plans through the steps of payment integrity program creation. Still sound like a little more than you’re ready for? Consider completely outsourcing vendor management.

By outsourcing vendor management, you can quickly implement a successful payment integrity program that your IT department can plug into. Consider what qualifies as “good” when it comes to vendor management: “Good vendor management allows your organization to build a successful and stronger relationship with your suppliers or service providers.” Can you really do that if your time, attention and money are caught up in developing software to manage vendors?

Final Thoughts

In an age where customer-centric technology projects are increasingly consuming the insurance industry, building a supplier management solution yourself may just be a waste of time. We developed Pareo® to specifically address the concerns of this industry: Function, Flexibility, ROI.

In fact, it’s not uncommon for Pareo® clients to see a 10x return on their investment. Read our latest case study to learn more.

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What makes value-based care programs work? 3 keys to success

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Communication Makes Digital Transformation Work

Communication Makes Digital Transformation Work

What happens after you choose a payment integrity solution? Learn how communication factors into successful digital transformation. Chances are, your health plan is undergoing some type of digital transformation this year, and you’re not alone. A recent survey of...

How to Vet a Third-Party Vendor for Your Health Plan

How to Vet a Third-Party Vendor for Your Health Plan

Pareo® makes it easier than ever to add third-party vendors to your payment integrity operations. Here’s a list of questions to ask new suppliers when interviewing them.

A strategic mix of payment integrity suppliers can propel your health plan’s cost containment efforts far beyond relying upon internal resources alone. Because Pareo® makes it easier than ever to add suppliers to your payment integrity operations, your health plan likely will want to pursue new partnerships. But not all suppliers are created equal. Your health plan will need to determine which suppliers will be the best fit for your organization.

What makes a good third-party vendor? Here’s a list of questions to get you started.

Technical Aptitude: Do they have the IT bandwidth to deliver needed files?

An ideal third-party supplier will be a partner to your health plan, working alongside you to find a solution. An organization that demonstrates an ease with technology should be a great fit with your health plan, as they’ll need to demonstrate technical aptitude in order to truly partner with you. If you find a potential supplier inflexible now, that attribute is unlikely to change as your needs grow more complex.


Red Flag:

If a third-party supplier does not have key insight into their operations regarding technical development, this may speak to a low technical aptitude. You should find out if they outsource their IT support, which poses a challenge to timelines and makes it less likely you’ll have direct access to those resources.

Pareo® offers great flexibility in this area, so suppliers won’t need to dedicate a significant amount of IT resources. However, a health plan needs to reduce technical complexity, so it’s important to align with a business partner who achieves that.

Communication: How is a supplier producing identifications?

It’s not just the volume of identifications that matters when choosing a supplier — quality matters, too. Suppliers need to demonstrate that they understand your health plan’s abilities in order to be an optimal partner. Ask a potential business partner if their reporting is more than just revenue goals. Your health plan will need more information than just dollars identified over a period of time. Other information that helps includes:

 Information that identifies current gaps in claims edits and other revenue functions


 Meaningful information (not just numbers)


Red Flag:

How much context does a supplier provide in their “reporting scorecard” (a common feature from third-party vendors). Often times, we see recoveries and numbers of identifications included but sometimes no context is given. Providing insights to payers is far more important, even though suppliers are limited to their own purview.

R&D: How often will a supplier be delivering new concepts?

Suppliers have the potential to be your own “Research and Development” shop. So you’ll want to establish how often a new supplier will be able to provide you with new concepts, which may also help you evaluate their ability to scale alongside your health plan. Furthermore, ask if the concepts are custom to your particular scenarios, or more broadly applicable to all their health plan clients.


Red Flag:

After implementation, can a supplier demonstrate that they’ve provided promised deliverables to other clients? Past adherence to deliverables is the best indicator of future performance. Pareo® allows you to see which suppliers are providing new concepts and how successful those concepts are over time.

Post Go-Live: After launching, will senior leaders still be involved with your account?

Senior-level engagement within the organization of a third-party vendor can be telling when it comes to value. Post go-live, engagement by upper management can go down significantly. Ask a supplier how they “hand off” clients internally, and how this will affect you. Establish a plan going forward.


Red Flag:

Your supplier’s plan should involve more than just selling you on additional services. Collaboration is key when forming a plan that moves you out of go-live and into an ongoing relationship. Focusing on revenue, rather than partnership, can lead to difficulties working with a supplier. For example, is there an additional cost every time you ask for something, like training?

A good sign that a supplier can provide the value you need is if they ask you for feedback. Suppliers with a focus on partnership and collaboration — that extends beyond launch — want to preserve their relationship with you. They will value your opinion and remain diligent about helping you solve problems, even those not included in the initial scope.

Other Considerations: Level of Commitment and Turnaround Time on Requests

Health plans want to evaluate the commitment of a potential vendor before engaging them as a business partner. As signs of commitment, expect an ideal supplier to give you multiple points of contact, rather than one individual. Access to a team allows for better communication and greater innovation. Additionally, identify resource allocation over time. Will fewer and fewer people be dedicated to your health plan as time goes on?

You’ll also want to ask a supplier about the turnaround time on requests. In general, does that time frame look like weeks or a year? Does the supplier have a very particular way of doing things (an established process, data formatting protocols) that require a lot of output/effort from your health plan?


Red Flag:

Who does the heavy lifting when your health plan makes a request? If you are working harder than a vendor on communication and execution, that’s a sure sign to take your business elsewhere.

Supplier Optimization: A Win for Everyone

Health plans need more suppliers to see larger gains in their recoveries. But ongoing management historically has been tedious (at best). Not so with Pareo® Supplier Optimization, a feature that allows health plans and suppliers to “plug in” to data sharing and even set KPIs, personalized to individual vendors. When information is readily available, health plans can easily add more suppliers and, in turn, those suppliers can quickly implement solutions.

Talk to ClarisHealth about how Pareo® can transform your health plan’s payment integrity operations.

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Top 10 Ways to Maximize Your Health Plan’s Recoveries

Top 10 Ways to Maximize Your Health Plan’s Recoveries

Want to maximize your health plan’s recoveries? Of course you do. Here’s how.

There’s a great deal of uncertainty in healthcare today, but one thing never changes: health plans’ desire to grow their recoveries. But, stuck dealing with insufficient technology or solutions that are siloed and not well connected, they can’t see the path to get there. We’ve written a lot of content about methods that health plans can use for growing recoveries, and summarized our findings below.



Download “Top 10 Ways to Maximize Your Health Plan’s Recoveries” infographic here.

What are the top 10 ways a health plan can maximize their recoveries?

Based on conversations with health plans across the nation, below is our roadmap to maximizing your recoveries. These ideas are likely familiar to you, even obvious. But, by leveraging the power of advanced payment integrity technology to put these solutions into play, health plans can grow their rate of recovery from an industry-average 1.2% to 7% or greater.

1. Simplify processes.

Complex administrative processes cause myriad problems for health plans. Heavy costs associated with unwieldy, manual tasks make controlling claim spend nearly impossible. The cost to coordinate benefits alone is estimated to be $800 million, leaving many health plans wondering what the answer is. Simpler, more efficient processes offer a smoother path to greater recoveries.

2. Add third-party vendors, stacked to greatest effectiveness.

Most health plans realize the benefits a third-party business partner brings to the table. The issue, however, is managing multiple vendors. With the right technology, health plans can easily onboard multiple third-party vendors and stack their focused expertise to optimize effectiveness.


“Pareo® makes onboarding new vendors much easier for health plans, and greatly streamlines the vendor effort needed to receive claim files, submit audits, and get real-time feedback on denials.”

3. Minimize provider abrasion.

Are you fully realizing the damage provider abrasion does to your recoveries? Problems with providers (often in the form of poor communication) can cause issues with claims resolution. Denials are costly for everyone, and new regulations aimed at interoperability are making it more important than ever to provide accurate information quickly.

4. Fast-track concept innovation.

Nearly a year ago we wrote, “health plans can maximize the value of third-party payment integrity vendors by factoring in their ability to facilitate research and development operations.” The same is true today, if not truer: concept innovation is at the core of health plan technology disruption. If that’s too edgy for your organization, scaling change across your health plan ecosystem is a very pragmatic yet proactive way to introduce concept innovation to your organization.

5. Integrate internal efforts.

Large amounts of siloed data are a natural byproduct of the digital healthcare landscape, but gone are the days when “big data” can be managed by spreadsheets alone. Now, health plans need a single source information portal to integrate payment integrity efforts across their organization. Internal efforts can be centralized to improve health plan recoveries by using an advanced technology solution like Pareo®.

6. Improve provider engagement.

Have you ever considered your net promoter score (NPS) — with your providers? How would they rank you to peers, and more pressingly, how does this affect your health plan’s ability to grow? Providers can become disengaged and disenchanted when processes (like medical records requests) are redundant or too vague. You can boost your provider NPS by focusing on improving the ways your health plan engages with health care professionals. For instance, Pareo® offers access to real-time data, allowing your plan to resolve questions with providers immediately.


“Health plans are increasingly interested in the Pareo® provider engagement module’s ability to streamline financial transaction management between payer and provider and significantly reduce friction inherent in traditional, paper-based methods.”

7. Expand internal capabilities.

Don’t be sold short: there’s more to payment integrity than just claims editing. The right technology solution should offer a return on investment that maximizes recovery efforts in real-time. Pareo® allows health plans and payers to expand internal capabilities, boosting ROI by eliminating unnecessary costs. For instance, reducing administrative work allows your talented staff to take on some post-pay efforts that your health plan may usually outsource.

8. Don’t overlook waste while looking for fraud and abuse.

Wasteful spending (defined by Health Affairs as “spending that could be eliminated without harming consumers or reducing quality of care that people receive”) accounts for a third of all healthcare spending in the U.S. But often, technology solutions sold to health plans only focus on fraud which, while important, is much rarer (only 7% of healthcare spending when combined with abuse). Pareo® combats fraud, waste and abuse by utilizing multiple technologies, such as, intelligent claims flagging and automated auditing workflows.

9. Focus on prevention.

Remember the famous Benjamin Franklin quote, “An ounce of prevention is worth a pound of cure.” That’s absolutely true for health plans who want to focus on payment integrity. The key to preventing leakage and bad claims? Optimizing your use of big data, which allows a health plan to make decisions faster, make meaningful progress on payment integrity, set up new value frameworks, deploy predictive modeling, and embrace transparency.

10. Embrace advanced technology.

If you haven’t already adopted a form of AI technology into your health plan processes, now’s the time. (And if you aren’t sure what AI is — and isn’t — read our primer here.) Integrating systems and processes is key to lowering health plan costs. Advanced technology gives health plans the capability to connect information in a single source portal to eliminate silos and improve efficiencies. In fact, we think health plans are in a better position than any other health organization to adopt and scale meaningful change by embracing technology.


Talk to ClarisHealth about how Pareo® can transform your health plan’s payment integrity operations.

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