Cost Containment & Care Quality


为您的国家机构和管理的医疗机构以最高的效率和最小的浪费运行, you need three basic things. 利益协调(COB)确保您只支付您负责的索赔. Payment Integrity (PI), also known as Program Integrity, makes sure that Fraud, Waste and Abuse (FWA) are under tight control, 索赔在医学上是必要的并且是正确提交的. 护理质量确保战略和服务到位,以改善护理和降低成本的最高程度的需要的成员.

Gainwell拥有让您的程序高效运行所需的经验和十大正规赌博平台大全排行, without impacting quality of care for your recipients.

Why Cost Containment & Care Quality?

Gain greater accuracy

Shut down fraudsters

Streamline processes with built-in compliance

How We Can Help

We pioneered Coordination of Benefits in 1985, 当十大正规赌博平台大全看到医疗补助支付了数十亿美元,这是不应该的. And today, our COB solutions for Medicaid, Medicare, Military, State Agency programs and MCOs are the best, most innovative available. 没有人能接近十大正规赌博平台大全的专有数据和算法.

十大正规赌博平台大全的PI十大正规赌博平台大全排行根除索赔周期中任何阶段因任何原因而出现的错误索赔. We identify incorrect claims before or after payment. 如果付款后,十大正规赌博平台大全有强大的恢复系统到位,让钱回到您的帐户. 十大正规赌博平台大全甚至可以在没有医疗记录的情况下发现不良索赔, reducing abrasion and speeding recovery. 机器学习和人工智能(AI)不断使十大正规赌博平台大全十大正规赌博平台大全排行更智能、更自动化, but when a human touch is needed, our people are the best and most experienced in the business.

Our advanced care management ecosystem puts personalized, data-driven and actionable care plans at your fingertips, 减少低效率,让你的团队专注于重要的事情——关心那些最需要的人.

Coordination of Benefits

Pre-payment Solutions

Cost avoidance beats pay-and-chase. Our end-to-end COB solutions focus on speed to delivery, and data quality and accuracy to create actionable insights. 这与十大正规赌博平台大全独特的市场专业知识相结合,确保为您的计划最大限度地节省成本.

Post-payment Recovery

Already paid that claim? No problem. 十大正规赌博平台大全使用人工智能和机器学习来检查不当支付的索赔,以选择最佳的恢复候选人. 然后,十大正规赌博平台大全使用高效的电子流程来追求这些回收,以最大限度地节省开支.

Case Management

Our Case Management solution makes sense of scattered, disorganized data, and drives cases to reimbursement and closure. We deliver secure, reliable, web-based access around the clock, with real-time updates, document imaging and a guided workflow. 十大正规赌博平台大全的案件经理和律师是无与伦比的,当涉及到复杂的,高美元的案件.

Payment Integrity

Clinical Claim Reviews

Our Clinical Claim Reviews identify coding, location, 通过将索赔与医疗记录进行比较来确定服务水平和报销错误, either pre-pay or post-pay. 由人工智能和临床专家协同驱动, 十大正规赌博平台大全经过实战考验并不断改进的算法针对最有可能出错的索赔要求.

Payment Analytics

Payment Analytics是一种可定制的付款后数据挖掘十大正规赌博平台大全排行,它使用独家数据分析将索赔历史与特定账单进行比较, coding, 客户端系统或索赔处理程序可能遗漏的使用和报销规则.


FraudCapture is a modular, 云托管平台,在识别欺诈方面提供端到端支持, waste and abuse. Beneficial to operations of all sizes, our intuitive, 移动友好型软件通过清晰的数据可视化和易于使用的数据探索工具暴露问题.

Pharmacy Payment Integrity

十大正规赌博平台大全的药房支付完整性十大正规赌博平台大全排行使用人工智能驱动的分析来针对高价值案例进行审查. Customization to specific policies and regulations is easy, 临床审查由工作人员药剂师和国家认证的药学技术人员进行.

Eligibility Verification

Better cost prevention also means better compliance. 许多雇主和州从那些不符合资格标准的人身上积累了高昂的财务成本, creating the need to verify eligibility more than ever. 十大正规赌博平台大全的资格验证十大正规赌博平台大全排行处理具有敏感性的验证, 确保员工准确理解为什么有些人可能不符合资格, and explaining the process every step of the way.

Utilization Management


Care Management

十大正规赌博平台大全的互操作护理管理平台建立在自动化的坚实基础之上, standardization and mature processes. Utilizing data from proven, 工业标准的COTS产品,如约翰霍普金斯ACG系统以及管理和临床信息, our service improves quality and reduces the total cost of care.

We can help. But the next move is yours!


Additional Insights

Generate Pre-Payment Claim Review Savings by Aligning Payer & Provider Incentives
How Pre-Payment Integrity Can Incentivize Evidence-Based Care