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Health plans often face challenges like complex claims processes, staffing gaps, and outdated systems, which result in missed opportunities for healthcare cost containment and medical claims recovery.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.