Health Plans Ready for the
Future of Payment Integrity
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.
If budget, time and expertise were no object, you could build the perfect custom technology solution for your health plan.
What’s on your wish list?
- Data analytics and predictive modeling to score claims for overpayment risk
- Reporting to identify root causes
- Tools to manage tight deadlines
- Platform to integrate fragmented data sources
- Secure access for all stakeholders to support seamless communication and foster engagement
The innovative payment integrity platform Pareo® is just the solution your health plan has been working towards.
"The typical healthcare payer’s internal IT systems and processes ... are plagued with disparate information systems, fragmented member information, legacy IT burdens, insufficient transparency in financial records, and inflexible, manual processes. The need of the hour in this regard is systems integration, data standardization and homogenized processes."
Break Down Data Silos
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 cost-containment 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
“The key to a successful implementation is recognizing the magnitude of the dependencies and creating high levels of coordination, both internally and with your third-party vendors. The ClarisHealth team has always been very responsive to our needs, and they operate in a highly transparent way. We appreciate their approach and partnership.”
Director Financial Investigations & Provider Review, Regional Health Plan
Latest Blog Posts
Competing with other health plan functions for technology priority can lead to missed audit claims cost savings potential. An integrated payment integrity strategy breaks down these internal silos. With so many moving – and vital – parts within a payer organization,...
Part 1 of our series on how the SIU can use artificial intelligence to overcome common challenges. Bringing together fraud and payment integrity efforts on a single A.I.-powered platform can accelerate health plan savings. Data and work silos have become a top barrier...
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...