Payment integrity program performance benchmarks showcased at inaugural Power of Payment Integrity Conference gathering of leaders from 35 health plans
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ClarisHealth Reveals Key Operational Performance Benchmarks for Payment Integrity Programs
ClarisHealth Named to Inc. 2025 List of the Fastest-Growing Private Companies in the Southeast for the Third Time
ClarisHealth, the only provider of an integrated payment integrity operations platform, today revealed it ranked on Inc.’s fifth annual Inc. Regionals: Southeast list. This year marks the third time ClarisHealth has been named to the prestigious ranking of the fastest-growing private companies in the Southeast. Continued hypergrowth attributed to increasing adoption of Pareo®, the industry’s only integrated payment integrity operations platform for health plans.
Research Proves Pareo® Payment Integrity Platform Yields Over 3x ROI for Health Plans
ClarisHealth worked with Hobson & Company to independently validate nine sources of value realized by health plans leveraging Pareo®. Findings published in white paper and self-serve ROI calculator.
Maximizing Opportunity with 2025 Healthcare Payer Technology Trends
What is on the horizon for healthcare payer technology in 2025? In this annual report, ClarisHealth experts review the trending drivers – and associated opportunities – so health plans can innovate payment integrity while minimizing risk.
ClarisHealth Reinforces Position as Payment Integrity Technology Innovator for Health Plans with a Banner 2024
ClarisHealth accelerates strategic growth into 2025 with thought leadership and expansion of Pareo® technology ecosystem. In another year of increasing complexity for healthcare, benchmarks across team expansion, technology innovation, and industry recognition achieved in 2024 demonstrate growing momentum in favor of ClarisHealth’s approach that offers health plans a better way to decrease payment integrity administrative costs while improving medical savings.
ClarisHealth Hires Ron Kozlin as New Chief Financial Officer
Technology industry veteran joins executive team to lead financial strategy supporting growth of Pareo®, the only integrated payment integrity operating system for health plans. In this chief financial officer role Kozlin will oversee enterprise-wide optimization of ClarisHealth’s financial operations.
ClarisHealth Unveils Pareo® Partner Exchange: Revolutionizing Payment Integrity for Payers
Payment Integrity industry’s first integrated ecosystem set to accelerate value delivery and reduce administrative complexity in $9B market. Groundbreaking offering addresses the growing complexity in vendor management and empowers health plans to leverage innovative solutions within Pareo and manage their end-to-end payment integrity program.
Buying payment integrity technology: 6 considerations
More health plans see the value in reducing administrative complexity to improve costs and payment accuracy. This step-by-step guide for payment integrity leaders buying enterprise technology ensures you reach those goals.
ClarisHealth Partners with Expion Health to Offer Enhanced Out of Network Claims Management Services on the Pareo® Platform
ClarisHealth, provider of the leading integrated payment integrity technology platform for health plans, announced a strategic partnership with Expion Health. ClarisHealth is pre-integrating Expion Health into the Pareo® platform to offer enhanced out of network (OON) claims management capabilities designed to detect and avoid more claims overpayments without additional IT costs.
ClarisHealth Opens Registration for the Only Peer-Led Payment Integrity Conference
Power of Payment Integrity, the industry’s only all-payment integrity, no-sales pressure conference, returns to Nashville, Tenn., April 21-23, 2025. The two-day educational event is free for health plans to attend.
ClarisHealth Makes the Inc. 5000 5 Years in a Row
ClarisHealth, provider of the industry’s only integrated payment integrity technology platform for health plans in elite group of consecutive-year honorees on the Inc. 5000.
Payment Integrity Leaders Reveal What Will Move the Industry Forward
Payment integrity leaders from the country’s top health plans take time to collaborate at POP Conference 2024. They find strength in community, innovative ideas, and a focus on 4 primary industry drivers.
ClarisHealth Awarded on the Financial Times Americas’ Fastest Growing Companies 2024 List for the Second Time
ClarisHealth, provider of the industry’s only integrated payment integrity technology platform, awarded on the Financial Times Americas’ Fastest Growing Companies 2024 List for the second time.
ClarisHealth Hires Nick Ridings as SVP of Health Plan Relationships
ClarisHealth, provider of the industry’s only integrated payment integrity technology platform, hires Nick Ridings as SVP of Health Plan Relationships to scale adoption of Pareo. Ridings is an alumnus of AIM Healthcare and Optum.
ClarisHealth Unveils New Brand to Complement Revitalized Mission
ClarisHealth, provider of the industry’s only integrated payment integrity technology platform, connects company’s modernized look to the continued evolution of the health plan market and their desire for advanced technology.
Improving Payment Integrity with a Building Blocks Methodology
Payers need a proven framework for payment integrity to create financial value, handle change, and engage at the highest levels of organizational strategy. This 5-step methodology works whether the directive is accelerating growth, building from scratch, or somewhere in between.
ClarisHealth Highest-Designated Major Contender in Everest Group Payment Integrity Solutions PEAK Matrix® Assessment 2024
Leading provider of enterprise payment integrity technology for health plans included in industry analysis report. Position credited to its unique adaptability to address payer pain points at multiple stages of their payment integrity journey.
ClarisHealth Secures Significant Growth Investment from Pamlico Capital to Accelerate Market Position with Health Plans
Leading provider of enterprise payment integrity technology for health plans partners with experienced private equity firm for minority growth round. Investment will expand the scale of operations, product innovation, and further the company’s mission to create a better way to drive claims payment accuracy.
ClarisHealth Hires Gary Eeds as Chief Operating Officer
Healthcare technology delivery veteran joins senior leadership team to scale adoption of enterprise payment integrity platform for health plans. As Chief Operating Officer, Eeds is excited to join ClarisHealth to continue the mission of removing administrative friction from healthcare.
ClarisHealth Makes the Inc. 5000 4 Years in a Row
ClarisHealth, provider of the industry-leading payment integrity technology platform Pareo®, today announced it ranked for the fourth year in a row on the Inc. 5000. ClarisHealth attributes its sustained revenue hyper-growth rate to health plans aggressively adopting Pareo to support digital transformation of their payment integrity operations.
Will Artificial Intelligence Finally Make Good on its Promise to Healthcare?
Artificial Intelligence is making the leap from much-hyped “trend” for healthcare technology to more widespread adoption. Here’s what A.I. is — and isn’t — and how health plans are proving its value. Artificial Intelligence for healthcare has come a long way since...
Payers Reduce Administrative Costs by Going Back to Basics with Payment Integrity
In the face of economic and hiring constraints, payment integrity leaders are prioritizing these 4 best practices to shift to an enterprise strategy that offers proven value.
Health Plan Leaders Speak Out on Building the Payment Integrity Organization of Tomorrow
Whether or not health plan leaders implement a fully centralized PIO, sharing information on an enterprise payment integrity technology platform helps overcome challenges and meet strategic opportunity.
ClarisHealth Ranks on Inc. 5000: Regionals Southeast List for the 2nd Year in a Row
ClarisHealth, provider of the industry-leading payment integrity technology platform Pareo®, today announced it ranked for the second year in a row on the third annual Inc. 5000 Regionals: Southeast list, the most prestigious ranking of the fastest-growing Southeast private companies, based in Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, Puerto Rico, South Carolina, and Tennessee. ClarisHealth attributes its sustained revenue hyper-growth rate to an industry shift toward innovation.
Study Reveals Payers Recover Overpayments 50% Faster with Enterprise Technology
In an industry that has struggled to quickly and meaningfully address healthcare claims payment accuracy, digital transformation once again proves its value. How can payers best take advantage of the potential of enterprise technology?
How Medicaid Managed Care Organizations Are Faring on Top 3 Issues
What can your Medicaid MCO do to prepare for this year and beyond? Medicaid managed care organizations are continually in a balancing act, facing tighter-than-average budgets, political pressures, and an evolving, uncertain healthcare landscape. The COVID-19 public...
For the 2nd Year, ClarisHealth Ranks on the 2022 Deloitte Technology Fast 500
ClarisHealth, provider of the industry-leading payment integrity technology platform Pareo®, today announced it ranked No. 485 on the Deloitte Technology Fast 500™, a ranking of the 500 fastest-growing technology, media, telecommunications, life sciences, fintech, and energy tech companies in North America, now in its 28th year. ClarisHealth attributes 248% revenue growth to the increased strategic importance of enterprise technology for health plans.
Pareo Clients Improve Payment Accuracy Results in Just One Year, ClarisHealth Study Finds
Pareo®, the industry’s leading payment integrity platform for health plans, reveals efficiencies and improved claims overpayment identifications and recoveries year-over-year, according to an internal study conducted by ClarisHealth business insights analysts. The study shows that Pareo clients recover overpayments 50-percent faster, increase recoveries 31-percent, and increase identifications 21-percent after the first year of platform adoption.
ClarisHealth Hires Tate McDaniel as Chief Revenue Officer
ClarisHealth, provider of industry-leading payment integrity technology for health plans, today announced that Tate McDaniel joined the company’s senior leadership team as chief revenue officer. McDaniel will lead the company’s integrated growth team to scale adoption of ClarisHealth’s enterprise payment integrity technology Pareo® in the payer market.
ClarisHealth Achieves HITRUST Risk-based, 2-year Certification to Further Mitigate Risk in Third-Party Privacy, Security and Compliance
ClarisHealth, provider of industry-leading payment integrity technology for health plans, today announced the Pareo® platform has earned Certified status for information security by HITRUST. HITRUST Risk-based, 2-year (r2) Certified status demonstrates that the organization’s Pareo technology platform has met key regulations and industry-defined requirements and is appropriately managing risk.
For the 3rd Time, ClarisHealth Appears on Inc. 5000, Ranking No. 2362
Today, Inc. revealed that ClarisHealth, provider of the industry’s leading payment integrity platform for health plans, is No. 2362 on the 2022 Inc. 5000 list. This is the third year running that the company has ranked on the list.
ClarisHealth Awarded No. 251 on Financial Times’ List of Fastest Growing Companies in the Americas 2022
ClarisHealth, leading provider of payment integrity technology for health plans, today announced it is No. 251 on the Financial Times’ list of the fastest growing companies in the Americas for 2022.
ClarisHealth Ranks No. 51 on Inc. Magazine’s List of the Southeast Region’s Fastest-Growing Private Companies With Two-Year Revenue Growth of 260-Percent
ClarisHealth, leading provider of payment integrity technology for health plans, today announced it is No. 51 on Inc. magazine’s third annual Inc. 5000 Regionals Southeast list. ClarisHealth is the fastest growing private company in Tennessee on the list.
ClarisHealth Honored in Forbes as One of America’s Best Startup Employers 2022
ClarisHealth, leading provider of payment integrity technology for health plans, today announced it has been awarded a spot on the Forbes list of America’s Best Startup Employers 2022 for the second year in a row. This prestigious award is presented by Forbes and Statista Inc. and recognizes the top 500 companies based on over 8 million data points evaluating employer excellence.
ClarisHealth Ranks No. 8 on List of Largest Healthcare IT Companies in Nashville
ClarisHealth, leading provider of payment integrity technology for health plans, today announced it ranked No. 8 on the list of Largest Healthcare IT Companies in Nashville.
ClarisHealth Ranked No. 462 Fastest-Growing Company in North America on the 2021 Deloitte Technology Fast 500
ClarisHealth, leading provider of payment integrity technology for health plans, today announced it ranked No. 462 on the Deloitte Technology Fast 500™, a ranking of the 500 fastest-growing technology, media, telecommunications, life sciences, fintech, and energy tech companies in North America, now in its 27th year.
Modernizing the SIU to Combat Healthcare FWA
For more than a decade, the SIU has relied on reactive business models. But with the rapid gains that artificial intelligence has made, health plans are beginning to embrace more adaptive technology, working smarter to deliver tangible results.
Payment Integrity Leaders Ready For A New Normal
With the ever-changing outlook of the payment integrity industry, now is the time to get ahead by making strategic investments in change.
ClarisHealth Named a Preferred Vendor by the Association for Community Affiliated Plans
ClarisHealth named a preferred vendor by the Association for Community Affiliated Plans, provides unique payment integrity and FWA technology platform for ACAP member Safety Net Health Plan digital transformation goals.
ClarisHealth Recognized By Gartner For Prospective Payment Integrity
ClarisHealth Recognized as Sample Vendor Offering Prospective Payment Integrity Solutions in Gartner® Hype Cycle™ for U.S. Healthcare Payers, 2021.
For The 2nd Time, ClarisHealth Appears on the Inc. 5000, Ranking No. 1941 With Three-Year Revenue Growth of 230-Percent
Inc. magazine today revealed that ClarisHealth, leading provider of payment integrity technology for health plans, is No. 1941 on its annual Inc. 5000 list.
A Better Way to Conduct Medical Claims Audits
With advanced technology, health plans can take control of their medical claims audits while achieving high ROI. Here’s how.
ClarisHealth a Winner of NBJ 2021 Best in Business Awards
Leading provider of technology platform for health plans one of 8 honorees selected for annual Nashville business award. ClarisHealth is honored to be declared a winner of the 2021 Nashville Business Journal (NBJ) Best in Business Awards. For over 30 years, the NBJ...
Vendor Consolidation Reduces Payment Integrity Innovation
What steps should your health plan take to ensure you get the most value from your services vendors and payment integrity efforts in the face of vendor consolidation?
Reduce False Positives in Healthcare Fraud Detection
Part 2 of our series on how the SIU can use artificial intelligence to overcome common challenges. A.I. can reduce the fraud false positive rate to make the most of your limited investigator resources.
Strategies to Move Your Payment Integrity Program Prospective
Payment integrity evolves into a more strategic function for health plans in order to reduce overall healthcare expense. Prepay drives greater cost savings but can be difficult to achieve. Here, we share strategies that can enable prospective cost avoidance programs...
Are You Hurting Provider NPS with Your Payment Integrity Efforts?
Look out for these 4 elements of payment integrity that may negatively impact provider NPS (net promoter scores) with your network providers. The Net Promoter Score (NPS) – an established metric traditionally managed by insights and marketing departments – can drive...
The Strategic Approach to Claims Cost Containment
Competing with other health plan functions for technology priority can lead to missed audit claims cost savings potential. An integrated payment integrity strategy breaks down these internal silos. With so many moving – and vital – parts within a payer organization,...
Using A.I. to Unite Fraud and Payment Integrity
Part 1 of our series on how the SIU can use artificial intelligence to overcome common challenges. Bringing together fraud and payment integrity efforts on a single A.I.-powered platform can accelerate health plan savings. Data and work silos have become a top barrier...
How to Evaluate Payment Integrity Solutions: The Ultimate Guide for Health Plans
Payment integrity solutions vendors make many claims. Here are the top 14 areas of evaluation to ensure a perfect fit for your health plan. Virtually every health plan is looking to address shrinking margins by moving their medical savings from a typical 1-2% today to...
Evaluate Payer-Provider Portals on These 4 Features
Go beyond the basics with a payer-provider portal that drives engagement and decreases costs. How would you characterize the health of your relationships with network providers? If yours is like many health plans, those relationships could always improve. And...
5 Steps to Reducing Fraud, Waste and Abuse
Use these tech-enabled tips to comprehensively reduce FWA. States require MCOs to take proactive measures that reduce not just fraud, but also waste and abuse. But how can you ensure your efforts not only meet compliance requirements but also help secure a competitive...
Increase Agility Around These 3 Hot Button Issues to Minimize Risk in Healthcare and Politics
The 2020 presidential election is upon us, and the debate surrounding healthcare and politics is more contentious than ever. How can your health plan stay ahead of the game, no matter the outcome? Every 4 years, the cross section of healthcare and politics is put on...
Your 5 Point Clinical Audit Checklist to Reduce Provider Abrasion
In part 2 of our series we outline exactly what health plans should look for in an advanced technology platform for clinical audit Paying claims right the first time – while making the most of internal resources – is the primary goal at most payer...
ClarisHealth on the Breaking Health Podcast
Listen to this conversation about building the right team and technology to help health plans tackle their entire payment integrity continuum. ClarisHealth CEO Jeff McNeese sat down with Steve Krupa, CEO of Healthedge and contributing host at Healthegy, for the latest...
“The Great Pause” Brings Unyielding Uncertainty to Medical Loss Ratios but Also Opportunity
Are better-than-expected medical loss ratios in 2020 setting up payers to take a severe hit on profit margins in 2021? Go on offense by making moves that feature these 4 risk-mitigating hallmarks. Six months into the novel coronavirus pandemic in the U.S., the crisis...
The Strategy Nearly Every Health Plan Considers: Outsource vs. Insource
Slim margins, fewer resources, and consolidation have made it harder for health plans to compete. Could balancing outsource vs insource efforts accelerate their goals? With shrinking margins, fewer and fewer internal experts, and increasing consolidation, health plans...
What’s your best path to adopting advanced FWA technology?
Take this interactive self-assessment to evaluate your current SIU successes and determine your health plan’s need for advanced technology to level up your fraud, waste and abuse mitigation efforts. More advanced technology solutions for healthcare fraud detection,...
You Don’t Need Rules to Mitigate Healthcare FWA
Health plan SIUs find deep learning models for fraud detection provide advantages over rules-based tools. The onset of the novel coronavirus pandemic highlighted a glaring weakness in rules-based FWA systems: the need to develop rules well ahead of their actual use...
3 Ways MCOs Can Prevent Fraud, Waste and Abuse
A robust fraud, waste and abuse program at MCOs and MAOs includes three key areas: Technology, Clinical Audit and Investigative capability. As your health plan grows its fraud, waste and abuse initiatives, there are three areas a strong prevention plan should address....
ClarisHealth Ranks No. 8 Among Tennessee Software Companies on the 2020 Inc. 5000
ClarisHealth Ranks No. 8 Among Tennessee Software Companies on the 2020 Inc. 5000 NEW YORK and NASHVILLE, Tenn., August 13, 2020 – Inc. magazine today revealed that ClarisHealth is No. 8 among Tennessee software companies on its annual Inc. 5000 list, the most...
6 Steps to a Successful Prepay Strategy
Health plans can take control of their own prospective provider audits instead of over-relying on services vendors with the help of advanced technology and access to proven analytics. We’ve written before about why it’s important for health plans to start thinking...
5 Reasons for Health Plans to Choose a Scalable Payment Integrity Technology Platform
Are you using an assortment of software tools to do work better suited to a platform? You might be missing out. When your health plan starts looking to upgrade your payment integrity and fraud management processes with technology, what do you turn to? A tool or a...
Health Plans Launch Innovative Solutions to Respond to Mental Health Crisis
Transparent data sharing supports seamless care coordination, relevant outreach that mitigates effects of chronic conditions. The novel coronavirus pandemic continues its near-perfect record as a harsh but effective teacher for the healthcare industry as it...
Health Plans Pursue Tech-First Strategies for Consolidation Success
How easy is it to merge valuable data when health plans form partnerships? Advanced technology provides the foundation for successful consolidation agreements. If you follow the tech scene at all, you may have seen the recent news about a failed autonomous vehicle...
4 Payer Responses to Primary Care Challenges
Primary care providers are the foundation of the healthcare system. With the pandemic putting its future at risk, health plans can take 4 steps to address this challenge. It’s been said that the coronavirus pandemic hasn’t created any new problems; it’s just escalated...
Health Plans Return to Payment Integrity
3 claims trends associated with the healthcare industry getting back to business, and how health plans can smoothly resume payment integrity efforts. Now that the crisis-volume of COVID-19 cases has started to ease across the country, delayed elective procedures and...
Healthcare Interoperability Poised to Solve COVID-19’s Big Data Crisis
Coronavirus highlights power of big data and the need for interoperability to improve population health. How can health plans lead the way? What’s the single biggest weapon used by government, pharma, academic researchers, healthcare systems, and health insurers alike...
Coronavirus New Normal: What does it mean for health plan members?
25 million Americans projected to lose employer-sponsored healthcare coverage due to the COVID-19 recession. How will this disruption affect the relationship between health plans and consumers? As of the end of April 2020, about 30 million people in the U.S. are newly...
Coronavirus Boosts Telehealth Adoption
The COVID-19 pandemic prompts payers to encourage the shift to telehealth, a move supported by patients and providers. How will this change the future of healthcare delivery? The novel coronavirus stopped traditional healthcare in its tracks, but there’s one bright...
Coronavirus Crushes Providers. Health Plans to the Rescue!
To support healthcare providers financially impacted by COVID-19, health plans rush to provide funds, ease administrative burden with prepay and engagement initiatives. Right now, the healthcare industry is in the thick of the novel coronavirus pandemic, with...
Your health plan’s best crisis response strategy? Innovation.
Health plans set themselves up for success – during a pandemic and beyond – by pursuing advanced technology to engage providers, satisfy members, and improve population health initiatives. The healthcare system is on the front lines of the novel Coronavirus pandemic,...
Do You Have a Healthcare Fraud Prevention Strategy Ready for COVID-19?
Artificial Intelligence allows health plans to more nimbly address FWA while reducing false positives To make an obvious understatement, the new coronavirus (COVID-19) pandemic is an event like we’ve never seen. While essentially the whole country is shut down, the...
Try Before You Buy: A bottom-up approach to health plan technology adoption
Why flipping the script enterprise software is the future of digital transformation? Have you ever tried a piece of technology at your health plan before it was adopted by the broader organization? Think about solutions like MailChimp, Survey Monkey, Slack and...
Health Plans: Take These 4 Steps to Comply with New Information Blocking Rules
Now that the rules promoting interoperability have been finalized, here’s how payers can prepare to take full advantage of the freer exchange of healthcare data. On March 9, 2020, the two separate rules issued by CMS and ONC against Information Blocking became final....
Diving Deeper into Healthcare Claims Audits: Part 1 – Auditor Workflow
The first installment in a multi-part series aimed at clinical auditors. Part 1 takes a closer look at 5 trends impacting how health plans manage claims auditing today. Claims auditing. It’s the core function of any health plan payment integrity operation. Ensuring...
Evaluate Advanced Healthcare Fraud Solutions in 3 Questions
How can your health plan tell if a fraud solution’s claims are valid? Just in the last year, dramatic leaps forward have occurred in advanced technology, and new healthcare fraud solutions have emerged to take full advantage of these improvements. According to...
Should Your Health Plan Build or Buy a Technology Solution?
Flexible solutions offer greater value to health plans. Whether your health plan has decided it has outgrown its manual paper-based processes or existing technology, at some point you will likely ask, “Should we build our own custom solution or buy something off the...
Data Privacy Concerns Meet Digital Progress
Data privacy and security will always be top of mind for health plans in an environment where access to data is crucial to growth. Here are some safeguards for payers. How do payers balance their need for broader access to data with their need to improve trust with...
Two Healthcare Technology Veterans Join ClarisHealth’s Board
Doug Ghertner and George Lazenby, IV, add significant expertise to the healthcare payer technology company’s board of directors NASHVILLE, Tenn., Jan. 30, 2020 – ClarisHealth, the company transforming health plan operations with its comprehensive payment integrity...
ClarisHealth Hires Mark Lavallee as Chief Growth Officer
Industry veteran will extend ClarisHealth’s strategic direction in accelerating adoption of market-leading technology solutions for health plans. NASHVILLE, Tenn., Jan. 20, 2020 – ClarisHealth, the company transforming health plan operations with its comprehensive...
Top 10 Reasons Health Plans Choose Pareo
It’s almost 2020, and forward-thinking health plans have a choice when it comes to total payment integrity solutions. From smaller regional plans with 100k members to large national health plans with millions of lives covered, Pareo scales to accommodate all needs....
Your FWA solution may not be as modern as you think.
The package may have changed, but the truth is most FWA solutions are still relying on legacy technology. 3 ways to spot the difference. To prepare for the advancing disruptions to healthcare, most plans we speak with have made some progress towards digital...
Where does your health plan reside on the payment integrity continuum?
Take this interactive self-assessment to determine how much progress your health plan has made towards modern digital transformation. The goal for every future-looking health plan is to transition payment integrity efforts from predominantly external post-pay, to a...
Tracking the Information Blocking Rule: It’s nearly final, but is the healthcare industry ready?
Despite public concern, the final rule is moving forward. Meanwhile, a recent survey says only 18% of healthcare execs understand the seismic implications. Both the Information Blocking Rule and the Interoperability Rule (collectively referred to as the Proposed...
No, Healthcare Can’t Pursue Fraud like Credit Card Companies. Here’s Why.
For consumers, the credit card fraud prevention experience is seamless, which leaves many health payers wondering why they can’t access the same technology. The short answer? It’s complicated. It’s easy to see how health payers, who have become disenchanted with...
Behind the Curtain: What to expect when you implement Pareo
Pareo is a unique platform that integrates with other software solutions to provide a comprehensive look at a health plan’s payment integrity processes. Here’s how we approach implementation of enterprise technology. Just got word that your health plan is adopting...
Why we focus on the problem, not the health care solution
ClarisHealth CEO Jeff McNeese shares how our tech company created a solution born directly out of the frustrations with the healthcare industry, by experienced healthcare workers. A major health plan client came to us recently and asked “Can you partner with us on...
Time to get social! How to cover social determinants of health without increasing complexity
Payers are starting to go all-in on social determinants of health, but coordination of care can be complex. A look at how technology can manage these high-impact initiatives. Already a trend for Medicaid, and now gaining steam among Medicare Advantage plans, payers...
Here’s What You Don’t Know about Fraud, Waste and Abuse
Fraud is different from Waste and Abuse, and most technology solutions don’t adequately address either issue. Think you know how to manage fraud, waste and abuse at your healthcare organization? CMS doesn’t agree. In fact, the promises of change and reform coming from...
Managing Medical Record Requests a problem? We’ve got the solution.
How to manage medical record retrieval processes with multiple clinical audit vendors.Is your health plan missing out on the potential of having multiple clinical audit vendors because you’re concerned about overlapping medical record requests? That uncoordinated...
5 Keys to Help Your Health Plan Focus on 2020
No crystal ball needed. Here’s what we see successful health plans doing now to prepare for 2020. It seems like once Labor Day passes, we prepare for the last half of the year no matter what the weather does. Pumpkin everything, dreams of cooler weather and … 2020...
Be the change agent you wish to see at your health plan
8 essential skills every change agent needs to navigate the future of healthcare Whether you’re already leading change at your organization or hoping to do so soon, most health plan employees need to be well versed in change management as the industry braces for rapid...
Prepare to Meet the Future with Data
We revisit ONC’s Information Blocking Rule, recap public comments, and look at how health plans can meet data sharing requirements. Earlier this year, we wrote about the ONC’s proposed information blocking rule and how it serves as an opportunity for health plans....
Can your tech do this? How to enhance your health plan members’ digital experience.
Health plans are shifting focus to ensure member satisfaction. Here’s how technology — even internal solutions — affect the digital experience of your health plan’s members. Do you ever think about how different banking is now compared to 10, 20, 30 years ago? First...
What makes value-based care programs work? 3 keys to success
Following up on our previous article, we look more closely at what successful value-based care initiatives have in common. It’s not all that surprising that one of our recent blog posts, Medicare for All: Should it be feared by health plans? has quickly become one of...
Communication Makes Digital Transformation Work
What happens after you choose a payment integrity solution? Learn how communication factors into successful digital transformation.Chances are, your health plan is undergoing some type of digital transformation this year, and you’re not alone. A recent survey of...
Should You Build Your Own Supplier Management Solution?
Take our quiz to help you decide if build or buy is right for your health plan. By now, you likely realize that your health plan needs a way to manage the many third-party vendors that allow you to maximize recoveries and optimize costs. The question is, should you...
Creating a Community of Users
When you adopt Pareo®, you gain access to a large community of health plan professionals offering shared expertise. From time to time, we like to remind our readers that “you don’t have to go it alone.” That isn’t just an empty catchphrase we use to market to new...
Lack of Documentation is a $23 Billion Overpayment Problem for Medicare
Medicare overpayment is a massive problem, and lack of documentation is a significant contributor. When we see errors adding up to billions of dollars in improper payments, we pay attention. As payment integrity technology experts and also healthcare consumers we take...