Fraud, Waste &amp; Abuse Companies

Product Info

Company Overview

Founded

2004

Employees

8,573

Funding Summary

Not Provided

Clients Your Size

About Cotiviti

Cotiviti is a leading solutions and analytics company that is reshaping the economics of healthcare, helping its clients uncover new opportunities to unlock value. Cotiviti’s solutions are a critical foundation for healthcare payers in their mission to lower healthcare costs and improve quality through higher performing payment accuracy, quality improvement, risk adjustment, and network performance management programs. The company also supports the retail industry with data management and audit services that improve business outcomes. Show More

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ClarisHealth

Reviews pending

Product Info

Company Overview

Founded

2013

Employees

0

Funding Summary

Not Provided

Clients Your Size

About ClarisHealth

ClarisHealth challenges the status quo for all payment integrity services to develop and deliver the most exceptional and innovative technology solutions addressing the real industry challenges of today and tomorrow for health plans. What sets us apart? TOTAL PAYMENT INTEGRITY™ brings it all together. ClarisHealth is dedicated to transforming engagement across the healthcare continuum. Connecting payers, providers and business partners with a single technology platform designed to support transparent communication. It's payment integrity -- illuminated. Technology: It’s all too easy to get bogged down managing the day-to-day of internal versus third-party resources. Our innovative technology PAREO™ allows us to provide... Show More

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WellRithms

Reviews pending

Product Info

Company Overview

Founded

Employees

0

Funding Summary

Not Provided

Clients Your Size

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Personify Health

4.0 (98)

Product Info

Min. Group Size

-

Lives Serviced

-

Average Cost

0 RFI Questions

0 Specific Questions

Product Features

Not Provided.

Product Description

Personify Health's claims system has software in place to support detection of potential fraudulent billing in order to secure higher reimbursements than what is owed. System rules and logic is configured to help... Show More

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6 Degrees Health

Reviews pending

Product Info

Company Overview

Founded

2012

Employees

141

Funding Summary

Not Provided

Clients Your Size

About 6 Degrees Health

6 Degrees Health is a service-first cost containment company. For many, we set care free from the constraints of traditional networks. For others, we bring integrity to historically opaque billing practices. For all, we leverage unparalleled clinical expertise and innovative data technology to empower employers and their covered employees in realizing the true benefit of healthcare.

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Bluespine

Reviews pending

Product Info

Min. Group Size

-

Lives Serviced

1,200,000

Average Cost

0 RFI Questions

0 Specific Questions

Product Features

Not Provided.

Product Description

Bluespine is an AI-powered healthcare payment integrity solution that discovers, recovers, and prevent medical overbilling. It helps self-insured employers fulfill their fiduciary duties by automatically removing overpayment violations before they are paid. Employers... Show More

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Case IQ

Reviews pending

Product Info

Min. Group Size

100 eligible

Lives Serviced

-

Average Cost

0 RFI Questions

0 Specific Questions

Product Features

Not Provided.

Product Description

Uncover, Investigate and Prevent Incidents and Misconduct

Case IQ is a powerful employee hotline and case management platform that streamlines your investigative process. Case IQ provides the data you need... Show More

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EBRAND Group

Reviews pending

Product Info

Min. Group Size

-

Lives Serviced

-

Average Cost

0 RFI Questions

0 Specific Questions

Product Features

Not Provided.

Product Description

Protect your business at every digital frontier with EBRAND’s Digital Risk Protection — a proactive, data-powered platform guarding your brand from external threats like phishing, fraud, domain abuse, social impersonation, and dark web... Show More

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finHealth

Reviews pending

Product Info

Min. Group Size

-

Lives Serviced

-

Average Cost

0 RFI Questions

0 Specific Questions

Product Features

Not Provided.

Product Description

finHealth is the market leader in Healthcare Payment Integrity, saving self-funded employers up to 10% on their total health care spend. Our mission is simple, to ensure that all claims are paid accurately,... Show More

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Milu Health

Reviews pending

Product Info

Min. Group Size

-

Lives Serviced

20,000

Average Cost

0 RFI Questions

0 Specific Questions

Product Features

Not Provided.

Product Description

Milu's BillFighter tool flags medical bills with potential mistakes, notifies employees of these potential mistakes, and offers to dispute the bill on their behalf. Bills with mistakes are flagged from claims or EHR... Show More

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Prime Therapeutics

Reviews pending

Product Info

Company Overview

Founded

1987

Employees

0

Funding Summary

None

Clients Your Size

About Prime Therapeutics

Everything we do is connected to helping people get the medicine they need to feel better and live well. It’s meaningful work and we’ve been doing it for over 20 years.

In the pharmacy benefit management (PBM)industry, we’re different. We’re owned by 18 not-for-profit Blue Cross and Blue Shield health plans. This allows us to control costs and empower our employees to put members first. It’s a successful combination. We have the lowest pharmacy trend in the industry and serve 27+ million members throughout the US.

In addition to core PBM services, we... Show More

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BMI Audit Services is now Lumelight

Reviews pending

Product Info

Min. Group Size

100 eligible

Lives Serviced

1,000,000,000

Average Cost

0 RFI Questions

0 Specific Questions

Product Features

Not Provided.

Product Description

See the description for Healthcare Claims Data Analytics Show More

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Innovu

Reviews pending

Product Info

Company Overview

Founded

2014

Employees

85

Funding Summary

Not Provided

Clients Your Size

About Innovu

Innovu is dedicated to helping advisors and their clients stay ahead of the curve regarding benefits strategy. Our SAAS platform and comprehensive menu of targeted solutions have been thoughtfully designed to help you optimize human capital risk management, health benefit design, and procurement through fully integrated claims data, predictive analytics, and health information insights. With Innovu, you'll not only be able to drive savings opportunities for your clients, but you'll also be able to provide financial reporting and tools for plan sponsors to adhere to the Consolidated Appropriations Act. Additionally, you can dive deep into the available data through the... Show More

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ClaimInformatics

Reviews pending

Product Info

Company Overview

Founded

2017

Employees

0

Funding Summary

Not Provided

Clients Your Size

About ClaimInformatics

At ClaimInformatics, we are dedicated to discovering and recovering improper payments on behalf of employers and administrators. We have designed a state-of-the-art, highly secure, HIPAA Compliant system that provides new levels of accuracy and transparency for improved payment integrity. This new platform has been designed to provide a granular forensic review of all healthcare claim transactions. We handle recovery and reconciliation of improper payments as well as detection of fraud, waste and abuse. Our process incorporates an end-to-end solution with corrective action plans. We have a continuous monitoring cycle and we deploy code auditing controls for pre-payment applications that favors... Show More

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Crumdale Partners

5.0 (1)

Product Info

Min. Group Size

-

Lives Serviced

-

Average Cost

0 RFI Questions

0 Specific Questions

Product Features

Not Provided.

Product Description

We offer protection from high-cost medical claims due to fraud, waste, or abuse with our active claims monitoring. Our expert clinicians and in-house pharmacists analyze claims, identify errors and implement improvements for savings... Show More

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WNS Global Services - North America

Reviews pending

Product Info

Company Overview

Founded

1996

Employees

30,366

Funding Summary

Not Provided

Clients Your Size

About WNS Global Services - North America

WNS (Holdings) Limited (NYSE: WNS) is a leading Business Process Management (BPM) company. WNS combines deep industry knowledge with technology, analytics and process expertise to co-create innovative, digitally led transformational solutions with over 375 clients across various industries. WNS delivers an entire spectrum of BPM solutions including industry-specific offerings, customer experience services, finance and accounting, human resources, procurement, and research and analytics to re-imagine the digital future of businesses. As of September 30, 2021, WNS had 49,511 professionals across 57 delivery centers worldwide including facilities in China, Costa Rica, India, the Philippines, Poland, Romania, South Africa, Spain, Sri Lanka, Turkey,... Show More

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Alliant Health Solutions

Reviews pending

Product Info

Company Overview

Founded

1970

Employees

0

Funding Summary

Not Provided

Clients Your Size

About Alliant Health Solutions

Alliant Health Solutions is a nonprofit organization driven to make health care better in the United States by improving quality of care, increasing the value of health care, and promoting prevention and treatment for chronic illnesses. Our family of companies provide professional services to state, federal and private partners, supporting the effective administration of health care programs and improvement initiatives. Alliant has three primary lines of service offerings that leverage evidenced-based methods, data and technology, and clinical expertise
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First Healthcare Compliance

Reviews pending

Product Info

Company Overview

Founded

2012

Employees

0

Funding Summary

Not Provided

Clients Your Size

About First Healthcare Compliance

We help create confidence among compliance professionals through education, resources, and support in the areas of HIPAA, OSHA, human resources compliance, and fraud waste and abuse laws. Our flexible, scalable, secure, cloud-based software allow organizations to: Share, track, and manage their compliance processes with ease; View compliance status in real time, across all locations; Have peace of mind that they are current in all federal healthcare regulatory areas.
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Integrity Advantage

Reviews pending

Product Info

Company Overview

Founded

2017

Employees

0

Funding Summary

Not Provided

Clients Your Size

About Integrity Advantage

Integrity Advantage is the way healthcare payers reimagine the value of their fraud, waste and abuse program. We’ve built our diverse knowledge base through decades of doing. Our experience providing support to dozens of plans across all lines of business, geographical regions, and varying enterprise priorities give our clients a tremendous advantage. We are a vendor neutral trusted advisor, providing objective perspectives and offering solutions for real challenges faced by the payment integrity industry. We offer advisory consulting, strategic planning, detection, investigation, medical review and training services to support program integrity initiatives in the identification and prevention of healthcare fraud,... Show More

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Qlarant

Reviews pending