Our Approach

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Craft a Payment Integrity operation from the ground up, infusing it with the magic touch needed to unearth over $100 million in potential annual medical expense savings for a health plan, like a financial wizard conjuring up a treasure trove of opportunities.

The Outcomes

Established a comprehensive Payment Integrity program​
Achieved annual medical cost savings exceeding $150M​
Realized remarkable 5:1 ROI​
Identified over 4% of members with other primary coverage​
Exceeded industry standard recovery rates​
Developed a gold standard Special Investigations Unit (SIU)​
Attained breakeven in under a year from program initiation​
Cultivated Payment Integrity culture within the organization ​