The Right Payment for the Right Member, for the Right Services, to the Right Provider
Deliver the highest quality services to your clients with the most innovative prevention and recovery solution in the industry.
With the increasing complexity and risks in health benefit administration, how are you maintaining and growing your competitive advantage while also controlling your costs?
$600 to $850 billion of annual U.S. healthcare spending is attributable to waste. Even more alarming? Nearly $9,000 per second is likely due to fraud, abuse, and administrative inefficiencies.
Pareo® Means Visibility
You no longer have to imagine a single solution for all your payment integrity needs. Pareo® is here to power our TPA Secure™ solution.
Expand Avoidance Opportunity
Ensure claims are paid right the first time with comprehensive, prevention-oriented solutions.
Optimize Recovery Costs
Strike the ideal balance between recovery results and costs to maximize overall program value.
Prepare for the Future
Rise to meet tomorrow’s payment integrity challenges. Rapid innovation makes it possible.
Prevention vs. Pay-and-Chase
What’s better than successful insurance claim recovery?
Getting the claim right the first time. Pareo™ clinical claim analysis and review of utilization and coding before you pay the claim: prepay clinical review. Plus, not all improper payments can be detected before the claim is paid by the insurance provider. As new information is received about each individual claim, retrospective analysis and review can identify significant additional overpayments and a number of other issues when you use the payment integrity suite from ClarisHealth.
Eliminate silos between different cost-containment departments.
ClarisHealth brings together the sophisticated healthcare analytics of its Pareo® technology and the brightest minds in the cost-containment technology industry to provide the most comprehensive solutions for retrospective over-payment identifications. From data analytics to DRG audits and Disallowed Charge reviews, we at ClarisHealth are providing revelatory competitive advantages to Third-Party Administrators and the customers they serve every single day.
Custom Query Data
Our Total Payment Integrity™ (TPA) Secure solution combines a robust library of proprietary clinical and policy edits combined with custom rules and alerts, and a system designed to allow for the ability to custom query data and generate ad hoc results for administrators. Put control of data mining in your hands and take advantage of seamless insource or outsource of validation requirements—all from a single pane.
Significant Savings with Cost-Containment Technology
The edits of our technology solution, Pareo®, are designed to identify coding and sequencing errors that can impact Diagnosis-Related Group (DRG) assignment. The result is millions of dollars in medical savings in inappropriately paid claims. It is the most comprehensive full-service DRG audit and workflow solution in today’s healthcare insurance payer marketplace, period.
Skilled Nurses & Coders
Ensure charges are warranted and necessary with the Disallowed Charge Review (DCR) solution from ClarisHealth. Our skilled nurses and coders are able to identify unnecessary charges and help ensure claim accuracy. Our team of nurses and coders also provide education about Pareo and other aspects of the Total Payment Integrity suite for your internal team.