Healthcare Payment Integrity Services

Pre-Payment Claim Review Services

Review claim queues before payment to verify patient eligibility, prior authorizations, and compliance with the payer’s standard billing rules, ensuring accurate, justified payouts.

Post-Payment Claim Audit Services

We analyze thousands of paid claims to identify unusual patterns (like a doctor billing for 30 hours of services in a single day) and assemble case files with the required documentation for faster recovery.

Coordination of Benefits Verification Services

When patient records or billing patterns suggest another health plan exists, we verify active policy dates and coverage terms to establish official payment order, update your database for future claims, and flag affected claims for adjustment.

Payer Enrollment Verification Services

Check official government databases to ensure the doctor has a valid state medical license, an active National Provider Identifier (NPI) number, and isn't banned from billing government health programs (like Medicare or Medicaid).

Medical Data Management Services

Data extraction, cleansing, deduplication, and structured healthcare data entry from unstructured claim records, clinical notes, and paper documents so payment integrity algorithms can analyze clean data with minimal errors.

Medical Coding Review Services

HIPAA-compliant medical coders who review medical codes, cross-reference clinical documentation against billed codes, and flag cases with coding & billing errors, unbundling, or missing billing modifiers.

Overpayment Recovery Support

Once we confirm an overpayment, we contact the provider's billing department by phone or email to track recovery and log every conversation in your CRM so anyone on your team can see the status and follow-up history for every overpaid claim.

Fraud, Waste, and Abuse Discovery Services

If a medical billing and coding error pattern looks suspicious (like charging for surgeries never performed), we freeze standard recovery efforts so the provider isn't tipped off, package the evidence, and hand it to your team for further analysis.

Insurance Claim Processing Services

Streamline your insurance operations with fast, accurate claim processing services. From intake and document verification to fraud detection and final settlement, we reduce cycle times, ensure strict compliance, and deliver seamless customer experiences.