Payment Integrity
- 26 years of national industry experience
- Relationships with more than 1,000 healthcare organizations
- More than $4 billion identified and successfully recovered
- Ability to automate over 80% of production-phase work
Overview
Anywhere from 2.5%-5% of paid claims result in overpayments, which can be devastating to your bottom line. Exela’s Payment Integrity solution is designed to identify inaccuracies to prevent future overpayments, rectify past overpayments, and recoup all dollars rightfully owed to your organization.
Run entirely on proprietary technology, our solution includes a sophisticated rules-based engine and table-driven architecture. That means we own the code, which streamlines operations and eliminates the need for third-party support. Once the system is configured to your needs, we are able to automate more than 80% of production-phase work.
Contract Management
Exela’s convenient, user-friendly system is designed to maintain provider contractual agreements and utilizes AI-driven technology to perform detailed analysis and determine expected payments. With unlimited contract years, the system serves as a foundation, supporting all immediate and future reimbursement initiatives.
Overpayment Identification and Recovery
Exela’s smart solution performs root cause analysis based on past overpayments in order to prevent similar mistakes in the future. Reviewing adjudicated paid claims on a daily basis and monitoring all paid or to-be-paid claims through their entire life cycle allows Exela’s system to catch overpayments early.
Predictive Contract Modeling and Benchmarking
Utilizing historical claims data, Exela helps you develop market-specific strategies to maximize your savings and determine expected allowed amounts for current and future agreements. Compare rates and get rate setting recommendations for further optimization.
Data Mining & Analytics
All 837/835 data is stored within the system, enabling easy retrieval, with no limit to queries. The intuitive dashboard features helpful reports on-demand to help you track and understand contract performance analysis. Root cause analysis is employed to help you identify and correct systemic issues, preventing future overpayments before they happen.
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