Artificial Intelligence is making the leap from much-hyped “trend” for healthcare technology to more widespread adoption. Here’s what A.I. is — and isn’t — and how health plans are proving its value. Artificial Intelligence for healthcare has come a long way since...
Search Results
Product Information
Will Artificial Intelligence Finally Make Good on its Promise to Healthcare?
How to Evaluate Payment Integrity Solutions: The Ultimate Guide for Health Plans
Payment integrity solutions vendors make many claims. Here are the top 14 areas of evaluation to ensure a perfect fit for your health plan. Virtually every health plan is looking to address shrinking margins by moving their medical savings from a typical 1-2% today to...
Top 10 Reasons Health Plans Choose Pareo
It’s almost 2020, and forward-thinking health plans have a choice when it comes to total payment integrity solutions. From smaller regional plans with 100k members to large national health plans with millions of lives covered, Pareo scales to accommodate all needs....
Behind the Curtain: What to expect when you implement Pareo
Pareo is a unique platform that integrates with other software solutions to provide a comprehensive look at a health plan’s payment integrity processes. Here’s how we approach implementation of enterprise technology. Just got word that your health plan is adopting...
Managing Medical Record Requests a problem? We’ve got the solution.
How to manage medical record retrieval processes with multiple clinical audit vendors.Is your health plan missing out on the potential of having multiple clinical audit vendors because you’re concerned about overlapping medical record requests? That uncoordinated...
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...
Creating a Community of Users
When you adopt Pareo®, you gain access to a large community of health plan professionals offering shared expertise. From time to time, we like to remind our readers that “you don’t have to go it alone.” That isn’t just an empty catchphrase we use to market to new...
Can your self-built technology solution do this? Why iterative software development is essential.
Health plans considering self-developed payment integrity technology should ask themselves: Do we have the resources to be agile? Iterative Software Development: A cyclical method of software development which focuses on improvements based on continual revisions and...
Put on your cape. Your health plan may just save the healthcare system.
Health plans are in a unique position to innovate with a trickle-down effect on providers and healthcare as a whole. It’s the plot to your favorite superhero movie (and with good reason): The odds seem insurmountable, and the path unclear but there’s a hero who sees a...
A Custom FWA Solution for Smaller Health Plans
Out-of-the-box Fraud, Waste and Abuse solutions just don’t cut it for smaller health plans. If you lead a health plan with fewer than 250k covered lives, you may think you’re out of luck when it comes to a comprehensive FWA solution. Some of the larger technology...
Top Trends for Healthcare Payer Technology in 2019
A look at the drivers, restraints, challenges and opportunities for healthcare payer technology in 2019. To view our 2020 industry forecast, click here. It’s 2019: do you know what’s going to happen in healthcare payer technology this year? We’re taking a thoughtful...
Here’s Where Provider-Payer Relationships Need to Improve
Communication breakdowns with providers wreak havoc on a payer’s bottom line. Imagine, if you will, two scenarios in a relationship between a healthcare provider and a health plan. In one, a provider receives a letter from a health plan telling them a claim is...
Thoughts on Creating a Centralized Payment Integrity Department
Does it make sense for your health plan to carve out Payment Integrity from your other cost containment efforts into a dedicated department with greater oversight capabilities? Historically, payment integrity efforts have been scattered among specialty departments...
Health Plan Vendors Don’t Have to Be a Hassle … If They’re Well Managed
Gain the oversight you need to manage your health plan’s third-party services providers. Recently, a client shared with us that the IT cost to bring on a health plan vendor was $70k. That stopped us in our tracks. $70k is, in our opinion, way too much for a health...
Don’t Settle for “Just” A Claims Editing Solution
Look beyond claims editing solutions and find a comprehensive solution to payment integrity. If your payment integrity strategy is limited to just a claims editing solution, your health plan is falling short on the payment integrity continuum. Health plans that think...
A Clearer Path to Coordination of Benefits
COB Considerations for Medicaid MCOs Coordination of Benefits. Many Medicaid health plans will tell you that this area is a primary concern in their payment integrity program. It’s no wonder: statistics tell us that 4-8% of Medicaid MCO membership has other healthcare...
What’s your ROI on a Payment Integrity Technology Solution?
Good return vs. bad return on investment and how your health plan can tell the difference When shopping for a payment integrity solution, you will understandably have many questions. Your COO is going to wonder how this software will improve operations, your IT...
Best Payment Integrity Results at The Most Optimized Cost
Integrative Audit and Recovery Solution Offers Top Value for Healthcare Payers Many of the healthcare companies we speak with often express concern when reconciling the concept of comprehensive payment integrity with day-to-day operational stressors, such as lowering...