Payment Integrity & Risk Adjustment

Maximizing revenue and ensuring accurate payments are paramount for organizations. The Felix PI – Payment Integrity & Risk Adjustment Solution is a comprehensive platform that combines advanced analytics and machine learning to optimize payment accuracy and risk-adjustable revenues. By analyzing vast volumes of data and identifying potential issues, our solution prevents payment errors, reduces fraud, and enhances risk adjustment strategies, resulting in significant cost savings and improved financial outcomes.

Features

Payment Accuracy

Achieve 95% accuracy with payment recommendations for pre-pay and post-pay claims, enhancing manual review efficiency.

Code Validation

Ensure compliance by validating CPT, DRG, ICD, and revenue codes, improving overall coding accuracy.

Fraud Detection

Detect and prevent fraud with advanced analytics, reducing financial losses from fraudulent claims.

Efficient Claim Denial Analysis

Identify and resolve claim denials promptly and accurately with powerful analysis tools.

Risk Adjustment Optimization

Use predictive analytics to improve patient outcomes, accurately capturing risk scores for higher revenues.

Revenue Forecasting

Predict revenue and manage financial risk, identifying coding gaps for increased revenue.

Compliance Monitoring

Ensure adherence to regulations with advanced reporting and minimize compliance risks.

Customizable & Seamless Integration

Tailor the solution to your needs and implement effortlessly with seamless integration.

Use Cases

Maximizing Cost Savings with Payment Integrity Analytics

Are you facing challenges in identifying and preventing payment errors, waste, and abuse in your healthcare claims? Do you struggle to manage the increasing complexity and volume of healthcare data and want to improve your payment integrity?

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