2025 Partners

AMS Intelligent Analytics

Website: http://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.

4L Data Intelligence

Website: https://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: https://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: https://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: https://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: https://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: https://www.hcfraudshield.com/

Healthcare Fraud Shield specializes in fraud, waste, abuse, & error detection and payment integrity for healthcare payers nationally by efficiently stopping claims prior to payment 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, and shared analytics across multiple payers resulting in higher ROI (up to 20:1) compared to other vendors. HCFSPlatform™ software platform 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 94 and client retention rate over 95%.

HCFSPlatform™ is a fully integrated platform consisting of PreShield (prepayment analytics & claim review logic), PostShield (post-payment analytics), AIShield (AI-driven analytic insights), RxShield (pharmacy and pharmaceutical specific analytics), Shared Analytics, CaseShield (SIU/PI case management), QueryShield (ad hoc query and reporting tool), HCFSServices (data mining, investigative, and record reviews), and HCFSAudit (Medical Record Review & SVRS). 

MedReview

Website: https://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: https://www.rialtic.io/

Rialtic is a next-generation platform that equips and enables players with the technology to take control of and execute their payment accuracy strategy. Rialtic’s first solution on the platform is a comprehensive code editing capability that combines the scope of editing typically found with both primary and secondary editors and merges it into a single platform supported by a modern user experience for managing policies, deviations, reporting, and provider inquiries. Our solution champions transparency — enabling greater understanding and control of your payment accuracy program and empowering payment accuracy teams to collaborate more effectively within their organization and with provider partners and employer groups.

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.

ASP-RCM Solutions

Website: https://asprcmsolutions.com/

Welcome to ASP-RCM Solutions – Your Trusted Revenue Cycle Management Partner

At ASP-RCM Solutions, we do more than manage revenue cycles; we forge partnerships that empower healthcare organizations to excel. Our mission is to deliver organization-driven solutions that adapt to your unique needs, ensuring a seamless and efficient revenue cycle process.

We recognize that every healthcare organization is distinct. That’s why we prioritize understanding your workflows, challenges, and objectives. From comprehensive medical coding and accurate billing to effective collections and accounts receivable management, we provide customized solutions designed to improve financial outcomes and operational efficiency.

Why Choose ASP-RCM Solutions?

• Proven Results: Our clients see an average increase of 25% in collections within the first six months of engagement.
• Accelerated Cash Flow: We reduce the average days in accounts receivable (AR) by 30%, helping you access revenue faster.
• Error Reduction: With industry-leading coding and billing accuracy, we reduce claim rejections and denials by up to 40%.
• Tailored Support: We create strategies based on your organization’s unique goals, whether you’re a small practice or a large healthcare system.

What Sets Us Apart?

• Dedicated Expertise: Our team of certified professionals brings decades of experience across all aspects of revenue cycle management.
• Technology Integration: We leverage advanced tools and analytics to provide transparency, real-time reporting, and actionable insights.
• Patient-Centric Focus: By streamlining your revenue processes, we enable you to prioritize exceptional patient care.

As your trusted partner, ASP-RCM Solutions is committed to helping you navigate today’s healthcare challenges and unlock your full potential. Let us help you maximize revenue, minimize inefficiencies, and focus on what truly matters – delivering outstanding care to your patients.

Ready to redefine success? Contact ASP-RCM Solutions today!

Codoxo

Website: www.codoxo.com

Codoxo’s mission is to make healthcare more affordable and effective for everyone and serves as the premier provider of artificial intelligence-driven solutions and services that help healthcare companies and agencies proactively detect and reduce risks from fraud, waste, and abuse and ensure payment integrity. Codoxo’s Unified Cost Containment Platform helps clients manage costs across network management, clinical care, provider coding and billing, payment integrity, and special investigation units. Our software-as-a-service applications are built on our proven Forensic AI Engine, which uses patented AI-based technology to identify problems and suspicious behavior far faster and earlier than traditional techniques. Our solutions are HIPAA- compliant and operate in a HITRUST-certified environment. For additional information, visit www.codoxo.com.

Iodine Software

Website: https://iodinesoftware.com/

Iodine Software builds transformative technologies that make healthcare work. Our proprietary AI engine, CognitiveML, automates clinical and administrative revenue cycle work, thereby improving reimbursement and enabling clinicians to focus on the delivery of high quality, patient-centric care.

Lyric

Website: https://www.lyrichealth.com/

Phare Health

Website: https://phare.health

Phare Health is transforming healthcare claims from retrospective to real-time processing. Built by former DeepMind and Google Health leaders, their AI engine has proven capable of automating complex inpatient claims while dramatically reducing revenue leakage. Starting with autonomous coding, Phare is expanding across the entire claims lifecycle - from prior authorization to payment. Their vision addresses the fundamental inefficiencies in healthcare payments: eliminating months-long delays between service and payment, reducing administrative costs, and reducing friction between payers and providers. Early deployments demonstrate a greater than 5x ROI for healthcare providers.