2023 Highlights
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Step into interactive discussions and engaging presentations on the key challenges and opportunities presented by payment companies.
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Step into interactive discussions and engaging presentations on the key challenges and opportunities presented by payment companies today:
PREVIOUS INDUSTRY LEADING SPEAKERS
William Rothbauer
Priscilla Alfaro
Michael Manley
Dutch Noss
Kara Suter
Stephanie Sjogren
Constance Taylor (ne' Boone)
Sophia Gin
Michael Menen
Michael McGauley
Michele Bear
Michele is a revenue cycle Executive Director, with oversight of revenue integrity, revenue cycle reporting and data analytics and front-end revenue cycle functions at Baptist Health & Baptist MD Anderson Cancer Center. She has over 30 years’ experience in healthcare operational, compliance and revenue cycle functions for both hospital and physician services. Michele holds multiple certifications in the healthcare industry.
Michele is a revenue cycle Executive Director, with oversight of revenue integrity, revenue cycle reporting and data analytics and front-end revenue cycle functions at Baptist Health & Baptist MD Anderson Cancer Center. She has over 30 years’ experience in healthcare operational, compliance and revenue cycle functions for both hospital and physician services. Michele holds multiple certifications in the healthcare industry.
Carl Brodarick
Tamar Goldblatt
Rani Khetarpal
Dale Carr
Dale Carr currently serves as Director of the Missouri Medicaid Audit & Compliance (MMAC) unit, which
has overall responsibility for Medicaid program integrity efforts. Dale has worked for the State of
Missouri since 2011. Director Carr was previously a Police Officer in Fallon, NV; an Investigator for the
U.S. Office of Special Counsel; and a Supervisory Special Agent with the Coast Guard Investigative
Service. Dale holds a Bachelor’s degree in Administration of Criminal Justice and is a graduate of the
158th Session of the FBI National Academy.
Mark Johnson
Chad Roswick
Marlene Mullen-Clayton
Dr. Michael Taylor
- Founder, Former President and CEO, MARS (MultiPlan Payment Integrity Solutions)
- President of MultiPlan’s Payment Integrity division
- Founded MARS as a technologically-enabled provider of healthcare payment integrity services for payers and third-party administrators
- VP of Operations at Executive Health Resources, acquired by Optum in 2010.
- Previously medical director for Aetna / Schaller Anderson, as well as co-Founder and President of a rural family medicine practice.
- Michael is a graduate of Vanderbilt University School of Medicine and Harvard College
Toni Case
Karen Weintraub
Dave Cardelle
Jake Hartberger
Kirstina Rollings
Rajasekhar Maddireddy
Mike Spellman
Raghavendra Pawar
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PREVIOUS GOLD SPONSORS
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.
Performant
Website: https://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 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 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 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 is headquartered in Livermore, California. Visit www.performanthealthcare.com and follow us on Twitter: @PerformantCorp.
PREVIOUS FRAUD, WASTE AND ABUSE PARTNER
Alivia Analytics
Website: https://www.aliviaanalytics.com/
Please visit our website for more information.PREVIOUS EVENT PARTNERS
AMS Intelligent Analytics
Website: https://www.mdstrat.com/
Please visit our website for more information.Forensic Claims Solutions
Website: https://forensicclaimssolutions.com/
At Forensic Claims Solutions we have an intense passion for finding value where our competitors cannot. The fluctuating dynamic with complicating healthcare reimbursement makes it difficult for payers and providers to keep up with. Our approach centers on the most difficult segment of the business, contract compliance. Our proprietary tool Sleuth© simplifies this complex dynamic. Capable of modeling both provider and payer perspectives, the engine accurately determines pricing and predicts future payments. Sleuth© will delve into pricing for all claim types and cover all lines of business. Sleuth© will reverse engineer contract and payment terms for DRG, Per Diem, Case Rates, Fee Schedule, Implants and Carve-outs all without ever looking at a contract pricing document. The anomalous payments Sleuth© produces are distinctive and generally passed over by most payment integrity vendors. We model each reimbursement strategy uniquely and let the data determine the outliers.
Our best-in-class concept library can also help amplify your results. We provide all whitepapers and pseudocode for each concept. You can utilize our library to freshen up stale concepts in your organization or leverage ideas that may have been previously looked over.
Healthcare Fraud Shield
Website: https://www.hcfraudshield.com/
Healthcare Fraud Shield specializes in fraud, waste, and abuse 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. FWAShield™ 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. FWAShield™ software platform was developed by industry leading healthcare subject matter experts and is a component of over 50+ clients’ including 16 Blue plans Payment Integrity/SIU departments. Our client satisfaction rating is exceptional with a net promoter score of 97 and client retention rate over 95%.
FWAShield™ – is a fully integrated platform consisting of PreShield™ (pre-payment), AIShield™ (AI), PostShield™ (post-payment), RxShield™ (pharmacy analytics), Shared Analytics™, QueryShield™ (ad hoc query and reporting tool) and CaseShield™ (case management).
PrecisionGx
Website: https://precision-gx.com/
PrecisionGx is an automated claims intelligence solution designed for healthcare payers to identify and recover millions in overpaid, incorrect, or fraudulent payments each year.
The PrecisionGx technology advantage is our customer's business advantage. Coupled with decades of subject matter expertise in data mining and audit, our claims-native AI engine enables payers to reduce vendor spend and identify more refunds earlier in the recovery lifecycle. These advantages allow us to outperform legacy vendors in payment recoveries and create transformative, AI-enabled prevention for the 75% of incorrect payments that existing vendors can’t address today.
PREVIOUS EXHIBITORS
ClaimShark
Website: https://www.claimshark.com/
ClaimShark is a cloud-based software platform for Payers to manage their end-to-end Payment Integrity processes including data, vendor, inventory, recovery, letters, documents, and appeals management with rich analytics and reporting. AuditShark is a cloud-based software platform purpose-built for Payer internal audit teams to help with Coordination of Benefits, DRG/Chart, Itemized Bill and Payment Compliance audits.
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. The Codoxo 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.
PREVIOUS Media Partners
Healthcare IT Today
Website: https://www.healthcareittoday.com/
Please visit our website for more information.Hospital and Healthcare Management Global
Website: https://www.hhmglobal.com/
Please visit our website for more information.Pharma Journalist
Website: https://www.pharmajournalist.com/
Please visit our website for more information.World Pharma Today
Website: https://www.worldpharmatoday.com/
Please visit our website for more information.
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