2024 PARTNERS
Headline
AMS Intelligent Analytics
Website: http://www.amspredict.com/
Please visit our website for more information.PLATINUM PARTNER
Health at Scale, Corp.
Website: https://www.healthatscale.com/
Health at Scale is advancing the next-generation of fraud, waste and abuse detection through real-time context-aware intelligence that allows health plans and third-party administrators to detect and act on inappropriate payments across pre-adjudication and post-pay. Founded by artificial intelligence and clinical faculty from MIT, Harvard, Stanford and U-Michigan, the company offers software solutions and fully-managed technology-enabled services to contain medical costs and reduce administrative burden. Health at Scale’s customers include some of the largest payers and TPAs in the U.S.; with the company’s breakthrough Precision FWA Detection™ technology consistently demonstrating 1-2% incremental reduction in total medical spend in large prospective deployments for Medicare Advantage and Commercially-Insured populations.
For more information please visit healthatscale.com.
NETWORKING PARTNER
4L Data Intelligence
Website: https://4ldata.com/
4L Data Intelligence™ uses the patented power of Integr8 AI™ to find, fight and prevent fraud, waste, and abuse fast with the revolutionary provider-centric FWA approach. Integr8 AI technology, coupled with our continuously credentialed provider database, detects FWA you can’t see with claim data-centric approaches, solving a challenge every payment integrity platform has today.
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, Integr8 AI dynamically and continuously detects provider behaviors, relationships, and outlier status 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 delivered in four distinct categories. These are:
- Provider Integrity Edits
- Adaptive Claims Edits
- Provider Behavior Analysis
- Provider Schemes Analysis.
For fraud and SIU teams, Integr8 AI detects fraud and collusion schemes you can’t see now, or can’t see fast enough, with claim-centric approaches. Our suite of tools automates continuous near real-time SIU-in-a-box detection and documentation so you can Find, Fight and Prevent Fraud Fast™.
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.
Data In Formation
Website: https://liberty-source.com/
Liberty Source PBC is a U.S.-based provider of technology-enabled human-in-the-loop data services that help companies realize maximum value from their Artificial Intelligence, Machine Learning, and Business Intelligence investments. Through its flagship DataInFormation brand, the company provides image annotation, data labeling, computer vision calibration, NLP validation, training data curation, prompt engineering, model monitoring / data lineage evaluations, and related data optimization services.
100% of facilities, operations and workforce are US-based to provide the highest level of information security; to minimize time zone issues; and to eliminate challenges arising from different cultural interpretations of data. 80+% of the staff are veterans or members of military families.
Liberty Source has deep domain expertise in a wide range of industry verticals. Extensive capabilities and a nimble culture are key differentiators that enable the company to fulfil even the most rigorous client requirements.
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.
Nokomis
Website: https://nokomishealth.com/
Nokomis was founded in 2013 by our current CEO Rich Henriksen to ensure Claim Accountability and make a difference in the healthcare system.
We are still privately owned and therefore only have to answer to our customers - that’s the way we like it.
Through 35 years in healthcare, Rich and his team compiled their deep and broad knowledge to build Nokomis and its proprietary technology, ClaimWise™. This unique technology finds patterns in claim data to identify claims for further review, regardless of dollar amount. Combined, ClaimWise™ and the Nokomis team intelligently select claims for review, finding errors even in claims that look fine at face value.
GOLD PARTNERS
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.
Healthcare Fraud Shield
Website: https://www.hcfraudshield.com/
Healthcare Fraud Shield specializes in fraud, waste, abuse, and error 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. HCFSPlatform™ 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. HCFSPlatform™ software was developed by industry leading healthcare subject matter experts and is a component of over 60+ clients’ including 7 of the 10 largest commercial insurers in the US. Our client satisfaction rating is exceptional with a net promoter score of 84 and client retention rate over 95%. HCFSPlatform™ – is a fully integrated platform consisting of PreShield (prepayment), AIShield (AI), PostShield (post-payment), RxShield (pharmacy analytics), Shared Analytics, QueryShield (ad hoc query and reporting tool), CaseShield (case management), HCFSAudit, and medical record retrieval.
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.
EXHIBITOR
Apixio
Website: https://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.
Penstock Group
Website: https://www.penstockgroup.com/
Penstock is a service partner and SaaS builder for forward-thinking health plans and providers, empowering recovery, audit and regulatory teams to get accuracy right from the start—when it matters most. Our mission is to create lasting systemic change that removes wasted spend from our healthcare system, returning dollars to payers, lowering the cost of care and improving access for all.
Penstock is powered by industry veterans who are some of the most sought-after payment integrity and regulatory experts in the industry. Our business model is rooted in transparency and the drive to reinstate true integrity in payment integrity—even if it defies traditional business sense.
Our audit workflow SaaS platform, ClearBridge gives health plans the tools and insights they need to identify overpayments, correct them and implement their own edits with ease, ensuring correct payments and mitigating future discrepancies.
When you partner with Penstock, you reclaim time and control with an end-to-end partnership that beautifully and seamlessly connects human and machine intelligence—to prevent recurring issues at the source.