ClaimInformatics provides a HIPAA-compliant platform that conducts pre- and post-payment reviews of healthcare claims to identify and recover improper payments, ensuring billing accuracy and compliance. By leveraging their ClaimIntelligence™ technology, the company helps employers and plan administrators recover 3-15% of healthcare spend, addressing the rising rates of improper payments in the industry.
Funding
$1.5M raised to dateRaised to date based on public sources. This may differ from the amount the company actually raised and is based only on what is publicly available on the internet.
Founders
Product
Problem
Healthcare plans face rising costs due to improper payments and billing errors, with some estimates suggesting that overpayments account for a significant percentage of total healthcare spending. Plan administrators and fiduciaries are responsible for ensuring compliance and protecting plan assets against overbilling, fraud, waste, and abuse.
Solution
ClaimInformatics offers a payment integrity platform that conducts pre- and post-payment reviews of healthcare claims to identify and recover improper payments. The company's ClaimIntelligence™ technology analyzes claims data to ensure billing and pricing accuracy, helping healthcare plans proactively decrease their healthcare spend. By identifying overpayments and recovering plan assets, ClaimInformatics assists plans in recapturing funds through diligent collection, reconciliation, and deposit of recouped funds.
Target Audience
ClaimInformatics primarily serves healthcare plans, plan administrators, and fiduciaries seeking to reduce healthcare spending and ensure compliance with billing regulations.
Features
- Pre-payment claim reviews to ensure billing and pricing accuracy before payment.
- Post-payment claim reviews to identify and recover overpayments on previously paid claims.
- ClaimIntelligence™ platform for data analysis and identification of billing errors.
- Recoupment services to collect, reconcile, and deposit recovered funds.
- Reporting and analytics to provide transparent results and insights into TPA performance.