Audience
Healthcare payers and providers in need of a payment-integrity-as-a-service solution
About Alaffia
Alaffia’s AI-powered system uncovers fraud, waste, and abuse in the most intricate healthcare claims to prevent and recover overpayments for payers and employers. Alaffia detects and corrects errors in misbilled claims before an improper payment is made. Alaffia empowers you to recover and save on overpayments previously made on misbilled claims. Overpayments on error-filled claims could be costing you hundreds of dollars per employee each year. Work with Alaffia to eliminate overpayments and drive more savings to the bottom line. The Alaffia system detects and corrects inaccurately billed claims, preventing overpayments. We work directly with your health plan or TPA for seamless integration and no disruption to your members. Our services are entirely contingency-based, so you only pay when we deliver savings. We ensure that providers aren’t charging your employees for services not rendered.
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Virtual Examiner
Virtual Examiner®, PCG Software’s flagship product, monitors the internal claims process of an organization to trend provider data for fraudulent and abusive billing patterns, and maximizes financial recoveries. PCG Software’s Virtual Examiner® allows healthcare organizations to enhance their current claims adjudication system with more than 31 million edits per claim. The software solution monitors an organization’s internal claims process to identify unclean claims and reduce payment for improper or erroneous coding to conserve premium dollars. Virtual Examiner® is more than a claims review solution with a focus on code combinations. It is a cost containment solution that evaluates the claim not only for abusive billing patterns but also identifies those claims that may involve third-party liability/coordination of benefits, case management opportunities, physician billing education and many other cost recovery reports.
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NovoHealth Dental
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Revenew
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DRG Claims Management
It’s fair to say that “not all DRG vendors are created equal.” Despite overlapping marketing efforts, there are two general categories of DRG auditing products: those that primarily serve provider hospitals and those that are designed to identify overpayments on behalf of health plans and payers. Just as an attorney typically specializes in defense or plaintiff representation, auditing vendors specialize in the unique needs, cultures and priorities of the parties they respectively serve. Even within the category of payer-based vendors, there is also a wide range of approaches to DRG auditing and overpayment identification. We extend our scope of services to our physician review team to produce clinical validation findings for situations where the identified issues are unsubstantiated clinical diagnoses documented by treating physicians and therefore exceeds the scope of coders. Our results prove that our coding compliance model will produce verified savings.
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Integrations
No integrations listed.
Company Information
Alaffia Health
United States
alaffiahealth.com
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