Prepayment Services


Financial Challenges to Health Plans

Today, increasing healthcare costs pose significant challenges to all health plans. Research has shown that almost 10% of all medical claims paid contain billing errors and overpayments are one of the most significant factors. Overpayments are costing health plans over $110 billion annually.

The complexity of medical provider billing practices contributes significantly to the issue of overpayments. The medical billing knowledge and labor needed to manually review all claims accurately is simply cost- and time-prohibitive.

These compelling financial challenges for health plans are what Healthalytica℠ addresses successfully for our clients.

How We Solve Claims Overpayments

Healthalytica understands that for most companies, manually reviewing medical claims for accuracy is simply cost prohibitive, so we’ve designed cutting-edge technology to improve the process.

Our Insight Engine is focused software that analyzes data for claims integrity. It scans claims data in real-time and generates results in minutes — before overpayments are made.

Insight Engine is rules-based and is dynamically updated with the latest trends in provider billing practices. Importantly, it is data-driven, identifying impactful billing patterns that might cause future issues.

Plan savings are significant with Healthalytica – with the potential of reducing gross plan expenditures by up to 2%.

How Insight Engine Works

Insight Engine forensically scans payment claims data and looks for any overpayments due to provider billing errors, fraud, waste and abuse. It is designed to identify trends in claims data which can adversely impact your plan’s bottom line.

Our Process

The process is simple and straight forward:

1. Clients send medical claims data to Healthalytica via an encrypted, HIPAA-compliant connection.

2. Healthalytica scans these data utilizing our Insight Engine to perform claims integrity.

3. Findings are returned to client before submitting for payment.

Let Healthalytica and our Insight Engine improve your bottom line today.