Payment Integrity Solutions

Helping managed care organizations and health systems uncover payment recovery opportunities
and implement new strategies for medical and administrative cost savings.

A Critical Lever in Total Cost of Care

A vigorous payment integrity program is an essential and often overlooked cornerstone for health plans seeking to optimize medical and administrative expense.

 

Our Payment Integrity services and solutions assist health plans to pay claims accurately, ensuring:

 

  • Member eligibility and covered services
  • Compliance with policies, rules and contracts
  • Responsibility attributed to liable party
  • Payments are accurate without overpayment or errors
  • Monitoring established for fraudulent or abusive billing or services
Hands holding piggy bank

Solutions for Improved Financial Outcomes

 

Clearlink’s Payment Integrity Solutions help our clients streamline payment integrity performance through optimizing their vendor ecosystem, establishing internal auditing capabilities, providing enterprise PI roadmap and governance, improving pre and post pay process improvements and realizing ROI in payment integrity investments.

VENDORMANAGEMENT

Expand existing vendor footprint and enhance vendor performance in payment integrity functions

PRE-PAY
FUNCTIONS

Develop pre-pay audits and edits to prevent inaccurate payments and reduce pay-and chase activities

DATA
MINING

Provide guidance on data mining and analytics to develop and implement new audit concepts

GOVERNANCE
& SHARED SERVICES

Deliver recommendations on workflow, resources, program governance and strategy for long-term growth in payment integrity functions

FRAUD, WASTE
& ABUSE

Optimize end to end process and workflows, align to government oversight standards, and build effective organizational FWA capability

“Our determination is in our tenacity to identify and prevent fraud, waste and abuse, creating opportunities to recover and prevent overpayments—real hard dollar savings”

Novelette Wallace,
VP Payment Integrity

Accelerate Your Payment Integrity Strategy Forward

 

Our thorough Opportunity Assessment is a two-day evaluation of your Payment Integrity operations. Leading experts from Clearlink will review your existing Payment Integrity services, including audit concepts, tools, software, vendor performance, organizational design, and more. The output of the assessment is a list of targeted opportunities and estimated savings so that you can be assured of value and confident in your selection of Clearlink Partners to optimize your Payment Integrity strategy.

Get started with your Opportunity Assessment Here!