2023 Partners

AMS Intelligent Analytics

Website: https://www.mdstrat.com/

Carelon

Website: https://www.carelon.com/

DRG Claims

Website: https://www.drgclaims.com/

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).

Lyric

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

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.

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.

Advent Health Partners

Website: https://adventhp.com/

Advent Health Partners is the leader in workflow agnostic technology applications across the various payer and provider payment and revenue integrity programs. Payers and providers recognize the need for Plug and Play technology to achieve healthy financials and solve manual challenges around clinical and coding activities. Advent Health Partners technology incorporates AI extractions and  models paired with an intuitive interface to ingest and normalize unstructured documentation and data to drive consistent, accurate, and improved clinical and coding determinations across numerous use cases within the payer and provider reimbursement integrity space.

Fathom Health

Website: https://www.fathomhealth.com/

Fathom is the leader in autonomous medical coding, applying cutting-edge deep learning and natural language processing (NLP) to produce complete coding results for patient encounters with zero human intervention. We deliver the highest automation rates and the broadest specialty coverage. Our AI technology reduces costs, increases accuracy, strengthens revenue capture, and shortens turnaround times from days to minutes. We carry out a risk-free trial to demonstrate our coding quality before your organization ever pays us a dollar. Fathom’s clients include leading health systems, physician groups, and revenue cycle management companies. Following our $46M Series B in November 2022, we are backed by world-class investors including Lightspeed and Alkeon Capital as well as leading health systems and healthcare executives including Cedars-Sinai, Vituity's Inflect Health, and Jonathan Bush.

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.

Phia Group

Website: https://www.phiagroup.com/

The Phia Group, LLC is an experienced provider of healthcare cost containment techniques offering comprehensive consulting services, legal expertise, plan document drafting, subrogation and overpayment recovery, claim negotiation, and plan defense designed to control costs and protect plan assets.

Rialtic

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

Rialtic is a modern healthcare technology platform focused on payment accuracy. Built by a team of seasoned industry veterans, Rialtic addresses the most important areas of the payment process. Payment policies are highly configurable and customizable: insurers can edit or build their own bespoke policies, while providers can analyze potential reimbursement levels. Robust analytics features across claims, lines of business, payments, and policies provides insightful business intelligence to users. By continuously sourcing, ingesting, and structuring healthcare payment policy documents and data, customers can confidently make up-to-date decisions.  Keeping security and compliance top of mind, Rialtic empowers healthcare organizations to work off the same platform with rigorous security controls, a standard in enterprise software.

ZOLL

Website: https://www.zolldata.com/