Payment Integrity Solution Overview
Exela’s Payment Integrity solution creates a seamless alignment between providers and payers, leading to efficient processing, cost reduction, and improved experiences for all involved. By using Exela’s unique technology and a team of professional subject matter experts, we eliminate unnecessary additional processing. This efficiency cuts down on the claims processing time and costs, which are often inflated due to reprocessing stemming from discrepancies with providers.
Exela’s comprehensive Payment Integrity approach addresses this issue through pre-submission edits, prepayment adjustments, collaboration portals, audits and analytics, thereby minimizing the friction between providers and payers.
Years National Industry Experience
Healthcare Organization Replationships
Boost your Clean Claim Rate with Exela’s Payment Integrity solution. Our Smart Edit Engine, including Proprietary Edits, SNIP, Clinical, and Billing Edits, is tailored for both EDI and paper claims. Apply our engine before submission to review and correct identified errors via our user-friendly portal and achieve precise medical coding and efficiency in your payment integrity process.
Pre-Payment & Post Payment Edits
Enhance your payment integrity solution with Exela’s Smart Edits Engine. Featuring Clinical Edits, Utilization Edits, Historical Edits, and more, our automated process provides a seamless workflow for requesting additional review records. Take control of your payment integrity, ensuring consistency and reliability.
Overpayment Identification and Recovery
Concurrent and retrospective review and recovery of funds for the most recent two to three-year period. Identify and correct systemic issues to prevent reoccurring inaccurate payments using root cause analysis.
Analytics and Healthcare FWA (Fraud, Waste, and Abuse)
Harness the power of Exela’s advanced analytics in healthcare FWA. Supported by AI with machine learning, our 24/7 detailed reporting and dashboard functionality offer immediate alerts and insightful root cause analysis. Gain a clearer understanding of trends and patterns, empowering your payment integrity solution.
Medical Coding & Audit
Trust Exela’s industry-recognized expertise in medical coding & audit. Using state-of-the-art technology and accredited global experts, we review medical records, pinpoint missing and erroneous content, and interpret medical necessity. Our medical coding and coding audit services ensure accuracy and compliance in every claim.