2024 Partners

AMS Intelligent Analytics

Website: http://www.amspredict.com/

Carelon

Website: https://www.carelon.com/

CGI

Website: https://www.cgi.com/us/en-us

Founded in 1976, CGI is among the largest IT and business consulting services firms in the world. We are insights-driven and outcomes-based to help accelerate returns on your investments. Across hundreds of locations worldwide, we provide comprehensive, scalable and sustainable IT and business consulting services that are informed globally and delivered locally.

Ceris Health

Website: https://www.ceris.com/

CERIS has 30 years of prepay and post pay claim review and repricing experience with a 97% client retention rate. Our solutions are deep, consistent, and defensible reviews, which make CERIS the partner of choice for health plans, Medicare and Medicaid plans, and third-party administrators. CERIS’ longstanding review services and clinical expertise offer incremental value and are grounded in a sincere dedication to our valued partners. CERIS' mission is to continue to grow and deliver long term Payment Integrity services for our partners and to help them save.

ClaimShark

Website: https://www.claimshark.com/

ClaimShark is a cloud-based software platform for Payers to manage their end-to-end Payment Integrity processes including data, vendor, inventory, recovery, letters, documents, and appeals management with rich analytics and reporting. AuditShark is a cloud-based software platform purpose-built for Payer internal audit teams to help with Coordination of Benefits, DRG/Chart, Itemized Bill and Payment Compliance audits.

Codoxo

Website: www.codoxo.com

Codoxo’s mission is to make healthcare more affordable and effective for everyone and serves as the premier provider of artificial intelligence-driven solutions and services that help healthcare companies and agencies proactively detect and reduce risks from fraud, waste, and abuse and ensure payment integrity. Codoxo’s Unified Cost Containment Platform helps clients manage costs across network management, clinical care, provider coding and billing, payment integrity, and special investigation units. Our software-as-a-service applications are built on our proven Forensic AI Engine, which uses patented AI-based technology to identify problems and suspicious behavior far faster and earlier than traditional techniques. Our solutions are HIPAA- compliant and operate in a HITRUST-certified environment. For additional information, visit www.codoxo.com.

DRG Claims

Website: https://www.drgclaims.com/

Healthcare Fraud Shield

Website: https://www.hcfraudshield.com/

Healthcare Fraud Shield specializes in fraud, waste, and abuse detection and payment integrity for healthcare payers nationally by efficiently stopping claims prior to payment using utilizing post-payment advanced analytics and artificial intelligence insights. We save health plans millions annually incremental to existing pre-payment processes using our unique and proven approach. FWAShield™ offers the combination of targeted rules, artificial intelligence, shared analytics across multiple payers resulting in higher ROI (up to 20:1) compared to other vendors.  FWAShield™ software platform was developed by industry leading healthcare subject matter experts and is a component of over 50+ clients’ including 16 Blue plans Payment Integrity/SIU departments.  Our client satisfaction rating is exceptional with a net promoter score of 97 and client retention rate over 95%. 

FWAShield™ – is a fully integrated platform consisting of PreShield™ (pre-payment), AIShield™ (AI), PostShield™ (post-payment), RxShield™ (pharmacy analytics), Shared Analytics™, QueryShield™ (ad hoc query and reporting tool) and CaseShield™ (case management).

Lyric

Website: https://www.lyrichealth.com/

MedReview

Website: https://www.medreview.us/

Headquartered in the financial district of New York City and serving all U.S. states and territories, MedReview has been a leading provider of payment integrity, utilization management and quality surveillance services for more than 40 years. A physician-led organization with a passion for ensuring that health care claims fairly represent the care provided, MedReview provides timely independent hospital billing audits and clinical validation reviews on behalf of health plans, government agencies and Taft-Hartley organizations, saving millions of dollars for its clients each year.

Trend Health Partners

Website: https://www.trendhealthpartners.com/

Combining the strengths of Trend, PrecisionGX and Advent, Trend Health Partners emerges as a pioneer in healthcare financial optimization, delivering unparalleled  payment integrity and revenue cycle expertise since 2010. As a trusted partner for providers and payers, we are dedicated to elevating payment accuracy and reducing administrative costs through our innovative, tech-enabled solutions. Our robust platform and clinical team operate as a seamless extensions of a provider’s business office, resolving credit balances, overturning denials and managing claims with precision and efficiency.

At Trend Health Partners, we personalize our approach to meet the unique needs of each client, ensuring the recovery and saving of billions of dollars while supporting their long-term financial objectives. We are committed to accelerating accurate reimbursements and enhancing revenue integrity by merging clinical insights, best practices, and cutting-edge technology.

Our mission extends beyond financials; we foster collaboration and transparent communication across the healthcare spectrum, offering a suite of services that drive significant value for all stakeholders. With a legacy of industry leadership, Trend Health Partners stands at the forefront of healthcare innovation. Together, we are setting new benchmarks for collaboration, transparency and integrity in the healthcare industry.

6 Degrees Health

Website: https://www.6degreeshealth.com/

6 Degrees Health is on a mission to reduce the cost of healthcare. We take a service-first approach to our Clean Claim Reviews to ensure accuracy in billing and fair payments. Using our extensive cost containment experience, clinical expertise, and next-generation, purpose-built software, we deliver remarkable savings for health plans. Our proprietary review process leverages CMS and other industry standard guidelines to evaluate every line item and identify billing errors and inconsistencies.

These pre-pay clinical reviews are completed by our team of highly trained and experienced registered nurses to ensure each billed line item is appropriate for reimbursement. This detailed review removes erroneous line items and verifies billing accuracy. Our comprehensive process manages claims during the review stage, as well as through payment and appeals resolution. Our white glove service on appeals allows us to maintain an uphold rate of 97 %, so your savings are secure.

Alaffia Health

Website: https://www.alaffiahealth.com/

HealthEdge

Website: https://healthedge.com/

Machinify

Website: https://www.machinify.com/

Machinify automates the healthcare claims lifecycle from prior authorization through final payment utilizing AI-powered software. At the core of Machinify is an AI cloud platform that digests and unifies policies, guidelines, and data transforming healthcare administration. 

Machinify's platform powers three revolutionary applications that interoperate for seamless execution across the healthcare claims lifecycle:

• Machinify Auth: Comprehensive system automating the submission and processing of ALL service authorization requests.
• Machinify Audit: End-to-end system utilizing GenAI and large language models (LLMs) to perform automated coding validation of complex claims.
• Machinify Pay: Software that enforces coding and payment policies against claims and prices claims accurately.

Varis

Website: https://www.varis1.com/

VARIS specializes in providing overpayment identification services exclusively to health plans specific to Diagnosis Related Group (DRG) coding and clinical validation and Outpatient/Ambulatory Payment Classification (APC) claims payments including ER/ED leveling, to identify and recover improper payments due to coding, billing, and processing errors.  We do so in either pre-pay, post-pay or onsite environments.

VARIS’ three-step process encompassing data analytics, human analysis, and complex medical record review allows health plans to recover maximum dollars in as little as six weeks. VARIS identifies up to 3% of your paid claims dollars using VARIS' proven approach.

VARIS works in a high-volume claims environment and our system is configured to manage large data sets. VARIS provides pre and post payment and onsite audit services to more than 40 health plan clients throughout the United States and Puerto Rico. Plans range in member size from 2,000 members to over 16+ million members.  VARIS is currently contracted with a variety of payer types including Medicaid Managed Care contractors, Medicare Advantage contractors, State Medicaid, Commercial payers, and Administrative Service Organizations (ASO) throughout the United States and Puerto Rico, ultimately representing more than 26 million members.

For more information visit www.varis1.com or call (916) 294-0860.