Healthcare Payment Integrity Solutions
Recover healthcare overpayments effortlessly. No provider disruption, no financial risk
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Delivering for our clients at scale
Recover overpaid medical claims faster and reduce healthcare costs
Health plans often face challenges like complex claims processes, staffing gaps, and outdated systems, which result in missed opportunities for healthcare cost containment and medical claims recovery. Our advanced AI-driven payment integrity solutions help you identify and recover erroneous payments efficiently, using a combination of pre-payment review services and retrospective audits. Our proven methods support healthcare revenue optimization while minimizing provider abrasion through clear communication, accurate billing practices, and full transparency.
*Source: Infosys BPM
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Build relationships
Leverage a national footprint with 1500+ healthcare providers for credit balance services.
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Drive ROI
With over 80% of recoveries collected, we help health plans cut costs, improve accuracy, and recover missed revenue.
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Control RX spend
Recoup up to 3% of total pharmacy spend with our pharmacy audit services.
Our solutions, your success
“Conduent’s approach to payment integrity is proactive and smart…the combination of innovative technology, seasoned healthcare experts and extensive recovery knowledge has made our decision to work with Conduent very successful…”
– Director of Payment Integrity, Regional Health
Maximize payment recoveries and prevention
With over 35 years of experience in payment integrity, our solutions seamlessly integrate with multiple data sources, analytics and technologies as well as feature a nationwide footprint to quickly recover the most funds possible. Save more and pass it to your customers with our bundled Payment Integrity Solutions.
Healthcare Payment Integrity - Commonly asked questions
What is healthcare payment integrity?
Healthcare payment integrity refers to the processes and technologies used to ensure that payments made to healthcare providers are accurate, appropriate and compliant with regulatory requirements. This involves verifying that claims are billed correctly according to healthcare policies, identifying discrepancies and preventing fraud, waste and abuse.
How does payment integrity reduce claim overpayments?
Payment integrity reduces claim overpayments through a combination of prevention, detection and recovery strategies that ensure payments are accurate and compliant. Conduent uses advanced analytics, automated audits and pre-payment reviews to identify inaccuracies or inconsistencies in submitted claims, reducing overpayments, ensuring compliance and improving overall payment integrity for healthcare and financial transactions. By proactively validating coding accuracy, eligibility and medical necessity before payments are processed, healthcare organizations can minimize errors, prevent improper payments and enhance cost management.
How can fraud, waste or abuse be detected in claims?
Payment integrity reduces claim overpayments by employing preventive measures, detection tools and corrective actions that ensure claims are accurate and in compliance with regulations. For example, detecting payment fraud, waste or abuse in healthcare claims involves leveraging data analytics, machine learning algorithms and rule-based systems to uncover suspicious patterns or anomalies. Payment integrity solutions use predictive modelling and real-time monitoring to flag potential issues such as duplicate billing, upcoding, unbundling or services that do not align with medical necessity. This targeted approach helps healthcare organizations identify risks early and take corrective actions promptly.
How does ED coding accuracy services improve accuracy?
Conduent’s Emergency Department Coding Accuracy Services improve accuracy by employing expert coders who specialize in ED care, ensuring proper ICD-10, CPT and HCPCS codes are applied based on thorough documentation reviews. The service includes real-time audits, compliance checks and AI-powered tools to minimize coding errors and ensure correct reimbursement. Continuous coder training, automated verification and data analytics detect discrepancies early, reducing claim denials and maximizing reimbursement. By maintaining adherence to regulatory standards and payer-specific guidelines, Conduent enhances operational efficiency, reduces financial risk and ensures accurate, timely claims processing.
What technologies are used in payment integrity services?
Payment integrity services leverage a combination of advanced technologies including artificial intelligence, machine learning, predictive analytics, natural language processing and robotic process automation. These technologies enable comprehensive data analysis, automated audits and predictive risk assessments, helping healthcare organizations to detect and prevent improper payments effectively while enhancing operational efficiency.