Healthcare Business Solutions Healthcare Payment Integrity Solutions Recover healthcare overpayments effortlessly. No provider disruption, no financial risk Connect with us Delivering for our clients at scale 7/10 top health plans are partners ~$1B recovered annually for health plans 135M covered lives served 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faster and reduce healthcare costs Health plans often face challenges like complex claims processes, staffing gaps, and outdated systems, which result in missed opportunities for healthcare cost containment and medical claims recovery.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 Build relationships Leverage a national footprint with 1500+ healthcare providers for credit balance services. Drive ROI With over 80% of recoveries collected, we help health plans cut costs, improve accuracy, and recover missed revenue. 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. Coordination of Benefits (COB) Services Increase recoveries, quickly identify other insurance and easily update member records accessing CMS, NAIC and more. Learn more Credit Balance Services Recover significant funds faster with our dedicated team that validates credit balances and handles recoupment whether it’s onsite, digital or over the phone. Learn more Subrogation Services Protect your organization from erroneous medical and disability-related payments backed by our own in-house attorneys and recovery specialists. Learn more Pharmacy Audit and Compliance Services Contain spiraling expenses and identify real-time discrepancies with our secure portal that enables provider oversight for existing audit programs and stand-alone service. Learn more Emergency Department Coding Accuracy Services Tap into an overlooked source of revenue with resources that ensure ED coding accuracy and that costs match the level of care. Learn more Featured insights Healthcare Payment Integrity Solutions by Conduent Watch now Stopping the emergency department payment hemorrhage Read the eBook Recovering millions for a nationwide payer Read the case study 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.
Coordination of Benefits (COB) Services Increase recoveries, quickly identify other insurance and easily update member records accessing CMS, NAIC and more. Learn more
Credit Balance Services Recover significant funds faster with our dedicated team that validates credit balances and handles recoupment whether it’s onsite, digital or over the phone. Learn more
Subrogation Services Protect your organization from erroneous medical and disability-related payments backed by our own in-house attorneys and recovery specialists. Learn more
Pharmacy Audit and Compliance Services Contain spiraling expenses and identify real-time discrepancies with our secure portal that enables provider oversight for existing audit programs and stand-alone service. Learn more
Emergency Department Coding Accuracy Services Tap into an overlooked source of revenue with resources that ensure ED coding accuracy and that costs match the level of care. Learn more