ClaimInformatics, Ltd.

With $3.2 trillion spent on healthcare in America, it is well documented that over 11% of those payments are a result of improperly paid healthcare claims.

At ClaimInformatics, we are dedicated to discovering and recovering improper payments on behalf of employers and administrators. We have designed a state-of-the-art, highly secure, HIPAA Compliant system that provides new levels of accuracy and transparency for improved payment integrity. This new platform has been designed to provide a granular forensic review of all healthcare claim transactions. We handle recovery and reconciliation of improper payments as well as detection of fraud, waste and abuse. Our process incorporates an end-to-end solution with corrective action plans. We have a continuous monitoring cycle and we deploy code auditing controls for pre-payment applications that favors the most effective configuration for your specific payer.

Our method of “auditing an employer’s group health plan”, has a two-pronged approach:
• Post-Payment services (review 100% of all claim payment transactions), and
• Pre-Payment services (fix the problem) to improve payment accuracy and limit future recoupment efforts.

Our clients will gain unprecedented insights into their true cost drivers through our ClaimInformatics team of industry experts and leading technology.