THE PLATFORM
Payment Integrity
Sophisticated algorithms that uncover costlyinefficiencies hidden in your claims data.
Turn Hidden Waste Into Measurable Savings
Our Medical, Clinical & Rx module delivers deep insights into medical and pharmacy claims, enabling proactive cost management and strategic intervention across your entire population. With advanced tracking, profiling, and analytics capabilities, you gain the visibility needed to identify high-cost patterns and optimize care delivery.
Medical + Clinical Guidance
Identify significant price variations for commodity medical services that indicate wasteful spending. Detect inefficiencies where procedures differ in cost based on billing locations. Expose questionable reimbursement practices and billing loopholes that drive unnecessary costs across your health plan.
Pharmacy Guidance
Uncover formulary inefficiencies including branded generics prescribed instead of lower-cost equivalents and therapeutic alternatives that offer equal efficacy at lower cost. Receive executive summaries with precise dollar amounts showing potential savings from formulary design changes.
Actionable Cost
Containment
Generate comprehensive reports detailing Best Buy Generics, Generic Equivalents, Generic Therapeutic Alternatives, and Branded Generic opportunities. Ideal for plan design and formulary optimization, this module enables ongoing, enterprise-wide cost containment initiatives with measurable ROI.
Don’t take it from us – listen to our customers
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