Next-gen solution transforms payment accuracy processes, driving savings and improved operational performance

CHICAGO: AArete, a leading global management and technology consulting firm, today officially announced its next generation Payment Intelligence® solution, which leapfrogs traditional payment integrity offerings by revolutionizing health plan operations and medical claims payment accuracy.

Payment Intelligence® accelerates review of claims and configuration across six critical pillars of payment accuracy, with one data feed and multiple analytic methods in one integrated solution. The AI-powered platform uses advanced claims analytics, a proprietary Doczy™ tool, and AI/ML models to find and fix the root cause of costly claims challenges at scale. The AI/ML models learn and adapt to new requirements and regulations at both the national and state level. They also incorporate plan-specific policies and contractual obligations into smart claims processing.

“Payment Intelligence® is breaking new ground, enabling health plans to pay claims more accurately and drive up to 5% in first-year medical claims savings, above and beyond savings identified by other vendors or internal processes,” said Maria Turner, AArete managing director. “Systematically eliminating inaccuracies creates productivity improvements in the claims payment lifecycle with multi-year impact for typical clients, including annual reductions of up to 18% in administrative costs.”

Payment Intelligence® has been engineered to navigate the complexity and nuances of provider contracts, plan policies, regulations and industry standards. The solution accommodates company policies and health plans’ unique business decisions, while seamlessly integrating critical details of provider contracts, such as rates and complex carveouts. Delving beyond CMS, Payment Intelligence® comprehensively addresses regulatory requirements (extending to state-specific rules), making it valuable to all lines of business. The solution is customized for each client, with state-of-the-art technology creating a seamlessly efficient process.

Learn more here: AArete Payment Intelligence® video

Payment Intelligence® offers health plans a fast track to ROI. The claims and configuration process leverages AArete's more than 15 years of deep expertise in healthcare consulting and is led by specialists who understand the industry complexities and client requirements. The client delivery team ensures rapid onboarding, reducing false positives, and swiftly translating insights into tangible value for clients.

“As a healthcare consulting leader, AArete is investing in practical AI solutions such as Payment Intelligence® to unlock and automate greater operational efficiency for our clients,” said Loren Trimble, AArete CEO. “At AArete, we Humanize Data for Purposeful Change® by combining our industry expertise with the power of AI and modern technologies to increase the speed, efficiency and accuracy of critical business operations.”

About AArete

AArete is a global management and technology consulting firm specializing in driving profitability improvement, digital transformation, and strategy & change for clients. Our cross-industry solutions are powered by a digital-first mindset, market intelligence, and data-driven approach to deliver purposeful change, actionable insights, and guaranteed results. We work across all industries and business functions to optimize profits in a compressed timeframe. AArete humanizes data by translating numbers into actionable insights, helping clients make better decisions and standing by their side to foster change with confidence, empathy and purpose. Learn more at AArete.com or follow us @AArete on LinkedIn.

Fonte: Business Wire