Coverself offers a cloud-native platform that automates payment integrity programs for healthcare claims, utilizing a customizable rules scripting language and an integrated rules library management system. This technology enables automatic claims correction and processing, reducing human intervention and streamlining workflow to enhance claims accuracy and efficiency.
Funding
$13.7M 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 payers face challenges in ensuring claims accuracy and preventing overpayments due to complex coding rules, evolving regulations, and potential billing errors. Manual claims review processes are labor-intensive, slow, and prone to inconsistencies, leading to financial losses and compliance risks.
Solution
Coverself provides a cloud-native payment integrity platform that automates healthcare claims analysis and correction. The platform features a customizable rules scripting language and an integrated rules library management system, enabling payers to define and enforce payment policies. By automatically identifying and correcting claims errors, Coverself reduces the need for manual intervention, streamlines workflows, and improves claims accuracy. The system is designed to be transparent and efficient, offering faster releases, self-customizations, and integrated workflows.
Target Audience
Coverself targets healthcare payers, provider-owned health plans, third-party administrators (TPAs), administrative services organizations (ASOs), management services organizations (MSOs), and payment integrity partners.
Features
- Customizable rules scripting language for defining payer-specific payment policies
- Integrated rules library management system with pre-configured code sets and reimbursement scenarios
- Automated claims correction and processing to minimize manual intervention
- Workflow, audit, and exception management capabilities for comprehensive oversight
- Payer-specific claims auto-correction
- Data mining algorithms for identifying new scenarios and innovating products
- Transparent platform designed for healthcare claims accuracy and faster releases