Health Plans Ready for the Future of Payment Accuracy

In the daily shuffle of inefficient systems and managing post-pay inventory, have you lost your focus on overpayment prevention? How about your ability to manage relationships with other departments, providers and business partners? Your health plan isn’t alone in these challenges.

Pareo® is trusted by top health plans to empower real innovation.

Optimize Payment Integrity

With a single platform to integrate fragmented data sources and secure access for all stakeholders to support seamless communication and foster engagement, payment integrity leaders have a holistic view into operations to enable innovative payment accuracy strategies.

Prevent Overpayments

Data analytics and predictive modeling to score claims for overpayment risk, reporting to identify root causes and remediate, and tools to manage prompt payment deadlines combine to push more efforts toward overpayment prevention.

Integrate FWA

The most advanced artificial intelligence powered detection available to payers, fully integrated with payment integrity, to reduce false positives, identify schemes proactively and find value in the unknown for modern anti-FWA.

What do our clients say?

Erik Chase | Quote C

“The flexibility of Pareo has been key. Instead of trying to put a square peg in a round hole, Pareo can integrate your processes into the workflow and help you get to the next level.”

Erik Chase, Director of Payment Integrity
Kimberly Jones-Schneider | Quote D

“ClarisHealth, off the shelf with Pareo, had already developed most of the 500 capabilities we had identified. And because of their structure, we have access to constant innovation that evolves ahead of our growing needs.”

Kimberly Jones-Schneider, Director of Payment Integrity Operations & Recoveries

Optimize Payment Integrity

Healthcare analytics rely on rules and statistics that assume the data will be well-structured, singularly accessible and accurate. But, claims data can be up to 70% inaccurate, most supporting information lives in inaccessible systems, and 50% of clinically relevant data isn’t formatted for ready analysis.

Imagine a world where your health plan can control all payment accuracy efforts through one integrated platform, rather than unwieldy spreadsheets and status emails. Pareo® payment integrity technology provides that control through unparalleled visibility.

 

  • Bring together disparate data sources
  • Manage third-party payment integrity vendors
  • Streamline medical records requests
  • Improve visibility into workflow and processes
  • Reduce provider abrasion

Improve Provider Relationships

Your health plan’s efforts around cost containment are the source of 90% of the friction with your network of providers. What’s more, that friction may be undermining your best efforts to improve member satisfaction.

Pareo® provides a solution to improve provider engagement with your health plan, through improved payment integrity processes. Payers and providers reduce costs while opening up the lines of communication. Your providers will agree; it’s a win-win.

 

  • Pay claims right the first time
  • Reduce false positives
  • Streamline clinical documentation requests

Maximize Third-Party Vendor Partnerships

What could your health plan do with more payment integrity vendors, stacked to everyone’s best advantage, integrated into your processes and onboarded with little to no additional administrative burden? Your payment integrity operations would really take off.

Concerns about the costs and management of third-party vendor relationships hold too many health plans back from enjoying the specialized expertise and increased efficiency these business partnerships can bring. Pareo® brings peace of mind to health plans so you no longer have to guess at the value of your your payment integrity vendors.

 

  • Expand your third-party vendor program
  • Minimize administrative lift
  • Fast-track new concepts
  • Ensure appropriate claim assignments
  • Real-time communication and recovery tracking

Major Contender in Payment Integrity 2020

Sample Vendor for Prospective Payment Integrity 2021 Hype Cycle for U.S. Payers

2020 & 2021

Industry Perspectives

Every week, our payment integrity and FWA experts analyze industry trends and opportunities to bring fresh perspectives to you. Here’s the latest:

ClarisHealth Awarded No. 251 on Financial Times’ List of Fastest Growing Companies in the Americas 2022

ClarisHealth, leading provider of payment integrity technology for health plans, today announced it is No. 251 on the Financial Times' list of the fastest growing companies in the Americas for 2022.

Webinar: How SIUs Can Embrace Adaptive Business Models

In this on-demand webinar, Karen Wright of Blue Cross of Idaho will share how her organization is preparing for the future by building a modern SIU that relies on proactive and adaptive business models to answer emerging trends in FWA.

A Vision for Payment Integrity

Season 2: Episode 6 - This season, as we have followed L.A. Care Health Plan's journey building a payment integrity function from the ground up, we've seen them go from a few thousand in unsolicited recoveries to $131 million in ...