Payment Integrity Solutions Faster Pre-Payment Reviews. Unparalleled Accuracy.

Accelerate your payment integrity program’s success with AI-powered payment integrity solutions and tech-enabled services that streamline and automate pre-payment claim reviews to increase efficiency, accuracy, and transparency.

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Accuracy. Speed. Value.

Deliver payment accuracy, unmatched speed, and expanded value on Apixio’s TrueCost™ tech-enabled payment integrity platform.

Itemized Bill Review

Complete IBRs in less than 15 minutes without compromising accuracy.

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Clinical Chart Review

Faster, simplified chart reviews with transparent, configurable workflows.

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Specialty Reviews

Accelerate reviews for high-cost drugs, readmissions, hospital bill audits, and place of service.

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Provider Portal

Enable a secure, user-friendly platform for seamless document management and provider communication. Learn More.

Key Points
Increased Accuracy And Efficiency
Complete Transparency And Control
Flexible SaaS, Service, And Hybrid Models

A New Kind of Healthcare Payment Integrity Solutions

Today’s healthcare payers often struggle with provider abrasion, lack of transparency, operational inefficiencies, and inaccuracies in their payment integrity programs.

Apixio is revolutionizing Payment Integrity for health plans, driving significant medical spend savings and delivering a strong return on investment (ROI). We offer a tech-enabled engagement model with unparalleled flexibility – choose between SaaS, Service, or Hybrid solutions. Our commitment to payment accuracy, powered by artificial intelligence (AI) and configurability, tailors solutions to your specific needs, providing end-to-end TrueCost platform transparency and real-time insights. Unlike others, Apixio meets you where you are in your payment integrity journey, ensuring a unique and seamless experience that translates into substantial savings and ROI.

Benefits

Configurable, Flexible Workflows

Configurable workflows to fit into current process to route claims to different reviewers or teams.

Efficient Tech-Enabled Capabilities

Use intelligent automation, OCR processing over 4,000 IB templates, and NLP SNOMED-level insights to review more claims in a fraction of the time.

Vast Content Library

Leverage over 400,000 concepts across all complex claims along with policies and contract information that can be configured to each client.

Program Transparency

Apixio’s platform provides real-time insights and control of their claims inventory and push button reporting, allowing plans to monitor their programs proactively.

The Impact

15 Min.

Reviews

15 minutes or less on itemized bill reviews

60%

Rate

60% change rate for DRG

15-20%

Savings

15-20% average savings per claim

99%

Sustainability

99% audit sustainability

Drive Savings with AI-Driven Insights and Analytics

Accuracy

Enhanced Payment Accuracy

Elevate your payment integrity program for pre-pay and post-pay with precision using AI automation for claims selection, built-in clinical content, and NLP for clinical data extraction to identify cost savings or payment recovery.
98% REVIEW ACCURACY
60%+ Change Rate
98% Audit Sustainability

Speed

Review Complex Claims in a Fraction of the Time

Effortlessly conduct complex claim reviews in minutes, not days, with the support of an integrated platform that harnesses API integrations and AI-driven automated workflows. This streamlined approach dramatically alleviates the administrative burden to meet the increasing demand.
REAL-TIME API INTEGRATIONS
<20 MINUTES TO REVIEW COMPLEX CHART REVIEW
PEND CLAIMS IN UNDER 0.5 SECONDS

Transparency

Complete Visibility and Configurability

Provide comprehensive insights and detailed breakdowns of every review to instill confidence in health plans and minimize provider abrasion. Monitor productivity and workflow efficiencies to enable quick adjustments to evolving claim demands.
DETAILED BREAKDOWN OF EACH CLAIM REVIEW
COMPREHENSIVE BUSINESS RULES & DEEP CONTENT LIBRARIES
CONFIGURABLE PRE-SCREEN AND EDIT RULES

Flexible

Flexible Engagement Models for Scalability

Leverage a PI platform that offers flexible engagement models for pre-pay and post-pay, scaling along with your business needs. Whether you prefer service, hybrid, or SaaS models, our platform is designed to adapt to your unique requirements.
MEET YOU WHERE YOU ARE AT IN YOUR PI PROGRAM JOURNEY
DEDICATED TEAM OF HIGH-QUALITY REVIEWERS
LEVERAGE THE SAME PLATFORM FOR OUTSOURCING AND INSOURCING

A Trusted Partner That Delivers

Our partnership with Apixio has led to substantial improvements within our payment integrity program.
Payment Integrity Manager
Payment Integrity Solutions

Itemized Bill Review

Apixio’s Itemized Bill Review (IBR) solutions use a claim selection engine, intelligent automation, and end-to-end platform transparency to provide access and insights into the rules, results, and reporting while increasing accuracy.

Clinical Chart Review

Apixio’s Clinical Chart Review solutions use a configurable analytic engine, tech-enabled workflows, and NLP data extraction and insight creation to accelerate the clinical and coding determination process.

Specialty Reviews

Apixio’s Specialty Reviews provide targeted solutions for complex areas like hospital bill audits, high-cost drugs, readmissions, and place of service. Using advanced NLP and contextual processing, our platform identifies discrepancies, optimizes cost management, and ensures accurate reimbursement for specialized cases.

Provider Portal

Apixio’s Provider Portal offers a secure, user-friendly platform for seamless document management and communication. By enabling direct uploads of medical records and itemized bills, the portal streamlines the document retrieval process and provides real-time access to claim statuses and educational resources.

AI-as-a-Service for Payment Integrity

Apixio’s AI-as-a-Service for Payment Integrity solution extracts clinical information from unstructured healthcare data into your existing workflow via API-driven integrations.
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Featured Resources

Safeguard Your Payment Integrity Success with Apixio

Explore how Apixio can support your organization’s transformation toward a pre-payment approach to payment integrity.