HEADLINE PARTNER
AMS Intelligent Analytics
Website: www.amspredict.com
Advanced Medical Strategies (AMS) is the premier provider of payment integrity, risk management, and business intelligence solutions to identify and address excessive claims, prevent and recoup overpayments, and effectively manage the risks associated with high-cost claimants and group health underwriting.
Find out more: https://pricetransparency.com/
PLATINUM PARTNER
6 Degrees Health
Website: www.6degreeshealth.com
- Pre Pay: Clean Claim Reviews/Itemized Bill Review
Leveraging decades of experience in clean claim reviews, clinical expertise, and next-generation, purpose-built software, we deliver industry-leading savings for health plans. Our proprietary review process evaluates every line item to identify billing errors and inconsistencies. Clinical reviews are completed by our team of highly trained and experienced registered nurses to ensure each billed line item is appropriate for reimbursement. White glove service is provided throughout the entire process from obtaining the itemized bill through any appeals and customized reporting.
- Post Pay: Data Mining and Recovery
We provide comprehensive overpayment identification and recovery solutions for Medicare Supplement, Dental, and Medical. Relying on over 20 years of concept creation, we identify 1-2% of total paid claims as overpayments. Our robust and unique recovery solution recovers 80 - 90% of overpayments as low as $25 with no provider abrasion. We have deployed solutions to 5 of the top 10 Med Supp carriers, and to 2 of the top 5 Dental carriers.
Machinify
Website: www.machinify.com
Machinify is the healthcare intelligence company helping health plans improve payment accuracy and efficiency across pre- and post-pay. Deployed by 85+ plans and representing 270M+ lives, Machinify's platform operating system combines AI with clinical, coding, and policy expertise to make better decisions at scale. We support COB, subrogation, itemized bill review, DRG audits, pharmacy, and data mining across commercial and government programs.
GOLD PARTNERS
4L Data Intelligence
Website: 4ldata.com
4L Data Intelligence™ is leading the way in a new era of healthcare program and payment integrity using the patented power of Integr8 AI Risk Detection™ technology to find, fight and prevent FWA in near real-time. Integr8 AI™, coupled with our continuously credentialed provider database, creates a revolutionary provider-centric capability to dynamically detect FWA you cannot see with stacks of traditional claims data-centric editing and analytics solutions.
The 4L FWA Prevention™ solution rapidly detects and prevents FWA at five points across the claims management workflow including pre pre-payment, pre-payment and post-payment positions. At each point, patented Integr8 AI technology dynamically and continuously detects provider behaviors, relationships and outliers without the limitations of rules-based and claim data-centric solutions. In short, it enables you to see what providers are doing individually, in relationship with all other providers, and in relationship to all other claims on each-and-every claim submitted.
4L FWA Prevention pre-payment and post-payment detection and prevention results are continuously delivered in four complementary modules. These are:
- Provider Integrity Edits
- Adaptive Claims Edits
- Billing Behaviors Analysis
- Provider Schemes Analysis.
For SIU teams, the new 4L SIU Hub™ packages the expanded range of Integr8 AI powered FWA detection behaviors and schemes into easy to use views with comprehensive investigation and lead management tools. This new capability increases FWA detection, reduces complexity and increases speed-to-decision on lead triage and investigation. All so you can Find, Fight and Prevent FWA Fast™.
Alivia Analytics
Website: www.aliviaanalytics.com
Your most expansive Payment Integrity and FWA partner for medical, pharmacy, vision, and dental claims. This features our powerful, configurable Alivia 360™ Platform that provides pre- and post-payment flexibility and considerable cost savings across the healthcare claims management process. It seamlessly transitions between FWA detection and Payment Integrity solutions including clinical and non-clinical audit scenarios, first- and second-pass claims editing, and COB/TPL. Alivia 360™ not only ensures comprehensive financial oversight but full adaptability to operational needs. Alivia integrates AI as an assistant, not a replacement, prioritizing ethical use, human oversight, and compliance with industry standards. Our solutions are offered as SaaS or tech-enabled services that build strong cases against inappropriate billing practices, identify new recoveries missed by legacy vendors, deliver actionable analytics, and offer automated corrections. Alivia enables healthcare payers to streamline vendor management, improving control and strategic decision-making. Schedule a discovery meeting and demo.
Carelon
Website: www.carelon.com
The health of the healthcare system improves when spending is responsible and accurate. Today, platform technology and advanced analytics are paving the way to make that more efficient and more proactive than ever before. Backed by decades of experience, Carelon’s Payment Integrity solutions bring together breakthrough technology and human expertise to help speed your ability to drive cost savings and value for your stakeholders.
CoventBridge
Website: coventbridge.com/healthcare-fwa-solutions
CoventBridge Group has more than 25 years of experience in the identification, prevention and investigation of fraud, waste, and abuse for our customers across the healthcare, insurance, financial and government markets with a proven track record of implementing and managing the largest programs in the industry. CoventBridge is the partner of choice supporting:
- Centers for Medicare and Medicaid Services managing the Unified Program Integrity Contractor program investigating Healthcare FWA since 1997
- One of the largest government agencies providing a national network of undercover investigators
- 700 National licensed employee investigators, many of which are former OIG, DOJ, FBI investigators
Program Management
• Audits & Assessments
• Compliance Assessment
• Medicare & Medicaid FWA
• On-site Audits
• Vendor Management
Document Retrieval & Analysis
• Medical Record Retrieval
• Medical Record Review & Coding (RN)
• Investigative Medical Record Review
• Medical & Healthcare Canvassing
Investigative Services
• Healthcare FWA Investigations
• Investigative Reports
• Clinical Surveillance
• Law Enforcement Referrals
• Alive and Well Checks
Staff Augmentation
• Data Analysts
• Investigators
• Nurse Reviewers
• RN Consultants
EXL
Website: www.exlservice.com
EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world’s leading corporations in industries including insurance, healthcare, banking and others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have over 57,000 employees spanning six continents. For more information, visit www.exlservice.com.
Healthcare Fraud Shield
Website: www.hcfraudshield.com
Healthcare Fraud Shield (HCFS) is a leading provider of fraud, waste, abuse, and error (FWAE) detection and payment integrity solutions for healthcare payers nationwide. Our platform stops improper claims before payment and detects issues after payment using advanced analytics, AI, and shared intelligence from a broad client network. With over 14 years of exclusive focus on FWAE and payment integrity, HCFS was built by industry experts to deliver measurable results. Clients typically achieve an average up to 10:1, and higher when leveraging HCFS Services.
Why HCFS:
- Enterprise-wide SaaS solution – Used by health plan teams across SIU/FWA, Payment Integrity, Risk, UM, Claims, Legal, Operations, and Finance
- 2,100+ FWAE rules – The largest FWAE rule library in the industry
- AI + Human-in-the-Loop – 11 AI models (FWA360Leads, AIShield, RecordPlus), all expert-validated
- Shared Analytics – Insights from 95M+ members across plans to uncover new, high-value cases beyond internal data
- 85+ external data sources – Enrich claims data for more precise detection
- Trusted by 70+ clients, including 7 of the 10 top commercial payers and 3 of the 5 of the top national payers
MedReview
Website: www.medreview.us
MedReview sets itself apart with over 50 years of experience delivering physician-approved pre-pay and post-pay payment integrity services that prioritize billing and payment quality, accuracy, and precision. Every claim reassigned by MedReview is reviewed, approved, and documented by a team of physicians, resulting in the industry’s lowest appeal overturn rate.
Utilizing proprietary technology combined with extensive subject matter clinical and administrative expertise, we achieve a 40% or greater reassignment rate focused on our clients’ specific needs. MedReview provides the full spectrum of payment integrity solutions including DRG and clinical reviews, cost outlier audits, re-admission reviews, data mining and itemized bill reviews.
Partnered with clients across the country, MedReview offers a flexible approach, supporting both complete outsourcing and supplemental enhancements to existing programs. By optimizing recoveries, preventing overpayments, and improving the provider experience, MedReview empowers payors to navigate the complexities of payment integrity with confidence and measurable success.
Rialtic
Website: www.rialtic.io
Rialtic equips payers with technology to enable payment accuracy capabilities, greater choice of policy options, easier response to a changing environment, and an overall lower administration cost.
Community Partner
CERIS
Website: 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.
DRG Claims Management
Website: www.drgclaims.com
DRG Claims Management (DCM) is an accuracy and integrity solutions firm, auditing claims for DRG (APR/MS) Pricing, Coding, and Clinical Validation, Cost Outliers & Itemized Bill Reviews, Readmissions, Short-Stay/OBS, Surgical Implants, Wound Care, and Skilled Nursing Facilities (PDPM/RUGs). Health Care Organizations partner with DCM to increase payment integrity savings and improve claim payment performance.
Our audits are completed on a Pre-pay, Post-pay, or Hybrid basis and encompass Tricare, Medicare, Medicaid, and Commercial payers.
Nokomis
Website: nokomishealth.com
Nokomis Health is a privately‑owned, Minneapolis‑based leader in Pre-payment Payment Integrity.
Founded in 2013, they leverage their proprietary ClaimWise™ platform alongside over 650 years of combined industry expertise to review every professional and facility claim—before payment—with next‑business‑day turnaround
They deliver an average of 9% incremental savings, uncovering coding errors, upcoding, and fraud that others miss—all at no upfront cost.
With a <2% appeal rate and <0.5% overturn rate, Nokomis ensures minimal provider friction
Their contingency‑based model aligns incentives and frees up critical funds for member programs and quality initiatives.
Performant Healthcare Solutions®
Website: www.performantcorp.com/home/default.aspx
Performant Healthcare Solutions® is a leading independent provider of technology-enabled audit, recovery, and analytics services in the United States with a focus in the healthcare payment integrity industry. Performant Healthcare Solutions® works with healthcare payers through claims auditing and eligibility (coordination of benefits)-based services to identify improper payments. The Company’s commercial health plan clients include both national and regional payers that represent more than 100 million covered lives across all lines of business, including commercial, Medicare, and Medicaid coverages. Performant Healthcare Solutions® also supports numerous engagements with the Centers for Medicare & Medicaid Services, including multiple Recovery Audit Contractor contracts and the Medicare Secondary Payer Commercial Repayment Center contract, as well as a contract with the US Department of Health and Human Services, Office of the Inspector General for complex claim review nationwide. The Company also features a call center to serves clients with complex consumer engagement needs.
Powered by a proprietary analytic platform and workflow technology, Performant Healthcare Solutions® also provides professional services related to the recovery effort, including reporting capabilities, support services, customer care, and stakeholder training programs meant to mitigate future instances of improper payments. Founded in 1976, Performant Healthcare Solutions® is headquartered in Livermore, California. Visit www.performanthealthcare.com and follow us on Twitter: @PerformantCorp.
Shift Technology
Website: www.shift-technology.com
Shift Technology empowers health plans to strengthen payment integrity with precision, fairness and speed at critical steps of the claim lifecycle. With a continually optimized edit library, enriched data, and advanced, healthcare-trained AI, Shift helps plans prevent errors and improper payments to maximize savings. Our SaaS-based solutions drive accelerated and insightful decision-making, helping health plans reduce costs and enhance operational efficiency.
SILVER PARTNER
Apixio
Website: www.apixio.com
Apixio, formerly ClaimLogiq, is the Connected Care Platform at the intersection of health plans and providers. Our AI technology and flexible services power risk adjustment, payment integrity, and care delivery programs using centralized patient health profiles, data-driven insights, and seamless workflows. By combining ClaimLogiq and the Apixio technology ecosystem, healthcare organizations can streamline operations, ensure accurate payment, and uncover critical patient insights—building a resilient foundation for success as the industry moves toward value-based reimbursement models. Visit apixio.com to learn more.
Codoxo
Website: www.codoxo.com
With a mission to make healthcare more affordable and effective for everyone, Codoxo is the leader in AI-powered payment integrity solutions for healthcare payers. The company's GenAI-driven Unified Cost Containment Platform delivers intelligent, end-to-end payment accuracy and fraud, waste, and abuse (FWA) detection from pre-claim through prepay to postpay. At the earliest intervention point, Codoxo's Point Zero Payment Integrity solutions identify and prevent payment errors before claims are even submitted—stopping issues at their source. Combined with the platform's comprehensive prepay and postpay capabilities—including advanced data mining, fraud detection, medical policy and contract compliance, medical record reviews, provider education, and intelligent audit and case management—Codoxo enables healthcare payers to achieve unprecedented accuracy across the entire claim lifecycle. Powered by generative AI and Codoxo's patented Forensic AI technology, the platform transforms payment integrity by shifting payers from reactive detection to proactive prevention, reducing costs and improving accuracy at scale. Codoxo is a Fierce Healthcare Innovation Award winner and has been recognized on the Inc. 5000 list for growth. Our solutions are HIPAA-compliant and operate in a HITRUST-certified environment. For more information, visit https://link.edgepilot.com/s/57167cca/YjEmYv2dokSB2REStzH5Cw?u=http://www.codoxo.com/.
Lyric
Website: www.lyric.ai
Lyric is the payment integrity Al company trusted by the nation's leading health plans at the beginning of the claims payment workflow. The Lyric platform is built on Al from the ground up and trained on 35 years of clinical expertise with real time integrations across 190 million lives. Lyric reduces wasted healthcare spending and ensures fast, accurate payments that drive transparency between payers and providers. Lyric is recognized as the 2025 Best in KLAS for Pre-payment Accuracy and Integrity.
Exhibitor
CAQH
Website: www.caqh.org
CAQH is the trusted data connector at the core of healthcare. For more than 25 years, the organization has powered the industry with the largest and most complete healthcare data foundation in the U.S., with more than 4.8 million provider data records sourced directly from providers and member data supplied by all national health plans. By improving how essential information flows across the system, CAQH helps healthcare operate more efficiently and with greater confidence. Learn more at CAQH.org.
HealthEdge
Website: healthedge.com
HealthEdge® is trusted to provide the technology and services that power health plans’ most important value streams. With an integrated platform of solutions spanning claims administration, quality improvement, prospective payment accuracy, provider network management, care management, member engagement and risk adjustment, HealthEdge enables health plans to converge their data so they can harness automation and the promise of AI. Combining this next-gen technology with services and expertise gives health plans unmatched capabilities to deliver a future of frictionless and cost-effective healthcare experiences. For more information, visit HealthEdge.com.
Penstock
Website: www.penstockgroup.com
Penstock is a high-performance payment integrity partner built for health plans that expect more—from their vendors, their audit programs, and their financial outcomes. We partner with national and regional health plans to deliver rigorous, transparent, and strategically aligned payment integrity programs that improve payment accuracy, uncover meaningful savings opportunities, and drive long-term operational value.
Our tech-enabled, human-led, auditor-controlled model combines deep payment integrity expertise with advanced data mining to uncover what others overlook and strong pre-pa chart review to pay the claim accurately from the start. Every finding is grounded in plan-specific policy, contract language, and defensible logic—designed to hold up under audit, appeal, and regulatory review. The result is real dollars avoided and recovered, recurring issues addressed at the source, and sustained improvements in payment accuracy.
Penstock’s post-pay work functions as a plan’s research-and-development engine for pre-pay. Through deep post-pay audits and ongoing data mining, our teams consistently generate new claim overpayment concepts each month. By analyzing claims with full context and clinical nuance, we identify not just individual claim overpayments, but the systemic patterns behind them—providing the insights plans need to strengthen pre-pay controls and prevent future leakage.
As consolidation across the payment integrity industry continues to reduce transparency and slow innovation, leading health plans turn to Penstock for precision, accountability, and results that compound over time. Ranked No. 353 on the 2025 Inc. 5000 list—top 50 in healthcare—and named the fastest-growing private company in the Northeast, Penstock is redefining what defensible, modern payment integrity should look like.
Vālenz Health
Website: www.valenzhealth.com
Vālenz® Health is the platform to simplify healthcare – the destination for employers, payers, providers and members to reduce costs, improve quality, and elevate the healthcare experience. The Valenz mindset and culture of innovation combine to create a distinctly different approach to an inefficient, uninspired health system. With fully integrated solutions, Valenz engages early and often to execute across the entire patient journey – from care navigation and management to payment integrity, plan performance and provider verification. With a 99% client retention rate, we elevate expectations to a new level of efficiency, effectiveness and transparency where smarter, better, faster healthcare is possible.
Zelis
Website: www.zelis.com
Zelis is modernizing the healthcare financial experience by providing a connected platform that bridges the gaps and aligns interests across payers, providers, and healthcare consumers. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients.
Media Partners
The Healthcare Data
Website: thehcdata.com
The Healthcare Data is an information-centric website that is dedicated to the healthcare industry online. Our platform serves as a comprehensive B2B resource, offering a wealth of valuable information to professionals and enthusiasts within the healthcare sector. Whether you are a healthcare provider, researcher, industry expert, or simply someone interested in staying informed about the latest developments, we have everything you need.
