Payment Integrity Consulting

Reclaim Your Power and Bring Payment Integrity Home

Your internal team is so much more than a recovery center. From training and education to technology and scale, we’ll help them transform into an intelligence powerhouse.

From Outsource to Insource: Your Roadmap to Seamlessly Bring Payment Integrity Back Home

In-house best practices for a future-proof health plan.

Payment Integrity Solutions

Make payment accuracy your strength, not your struggle

We arm you with the tools to self-serve by making payment accuracy a core in-house competency. From building robust audit workflows to transparent training, tech and education, we help you find more recoveries while fostering a smoother, happier experience for all parties—including your members and providers.

Workflow Development & Training

As your advocate, we share our expertise, teaching you to spot and correct systemic errors that drive costs up. We’ll evaluate your concepts and establish effective workflows, edit logic and clinical parameters for validation.

Build a Best-in-Class Team

We’ll help you build a powerhouse team. By crafting job descriptions, interviewing candidates, establishing performance metrics and training, we ensure you have the right resources in place for success.

Make Accuracy a Core Competency

We become a seamless extension of your organization—with ongoing support to help you cultivate a best in-class in-house payment integrity division that sets a new standard of accuracy and industry excellence.

We're Big On Impact

Our team is focused on driving positive change at every turn, from empowering auditors to driving cost savings. But we believe in the power of experience over promises—so we invite you to witness our commitment in action.

$90M

We’ve identified Federal and State carve-outs valued at $90M

$170M+

We’ve recovered $170+ million in HCRA overpayments for health plans in NY

98%

Our IRO agree rate is IRO agree rate is 98%

Build Trust with Providers

By understanding the exact cause of an overpayment, you’re equipped with the proof you need to diffuse tension, fix the root cause of the issue and build trust with your providers.

Lower Your Costs

We’ll nurture your team into masters of payment accuracy, giving them the skills and technology needed to build their own edits and reduce the financial impact of inaccuracy.

Fast-Track Response Times

We can teach your team how to quickly identify and correct overpayments and implement edits that prevent recurring errors and minimize member disruption.

Empowering Your Team

We give your team the tools they need to help your organization succeed. Watch them transform into an unstoppable force.

Getting Clear on Healthcare Costs

We work like a true extension of your team—and your success. When you win, we win at reimagining the way care is paid for.

Audit Management Technology

Say goodbye to the IT waiting game and hello to seamless self-service with an all-in-one audit workflow platform that boasts intuitive search, reporting and user-friendly edit development.

Get Started Today

Ready to build a future-proof, in-house payment integrity program? We’ll help you build or refine your program—so it’s infused with accuracy and forward-thinking at every corner.