Payment Integrity
Sagility’s approach to Payment Integrity (PI) is a collaboration between our coding and clinical teams that provides predictable operational excellence through analytics-led, technology-driven solutions. Backed by our proprietary Intelligent Content Processing™ (ICP) software, we deliver high quality, broad automation driven by more accurate findings. Through our HITRUST certified platform, Contract Central, we provide Data Mining and Claims Repricing solutions that enhance claims payment accuracy and ensure significant savings in both pre and post-pay.
$1.7B in annual savings in pre-pay- $740M in annual recoveries in post-pay
200% increase in clinical hit rate achieved through automation- 40% reduction in disputes
Contact us now to explore our full suite of services, including Data Mining, Clinical Audits, and Intelligent Content Processing.
Data Mining and Repricing, Fueled by Contract Central
Sagility comprehensively addresses client data needs by utilizing data mining and provider contract repricing to rectify system gaps, query for aberrant claims, detect overpayments, and initiate recovery. We deploy industry and client-specific rules, tailoring our Contract Central platform to each client’s unique claims payment ecosystem. An example of our flexibility to varying requirements is our Medicaid claims repricing, through which we alleviate payers from the burden of tracking pricing changes and methodologies across states. Our data mining solutions deliver results including:
- – Up to 4% savings of your auditable spend
- – Reduced payer-provider abrasion
Clinical and Coding Audits, Powered by Intelligent Content Processing
Clinical and Coding reviews require provider sensitivity and active client communication. We engage with our clients to design the best program for their facilities, coders, and medical directors. Our program starts with our own doctors, nurses, and coders gaining familiarity into your requirements, and aligning with your expectations. We help you retain and improve provider satisfaction, while also ensuring your organization is processing claims in alignment with the medical record.
Our ICP tool is responsible for rapid digital consumption of medical records, and achieves the following:
- – Applies incremental and detailed flags to medical records
- – Closed-loop feedback for timely and comprehensive claims reviews
- – Unparalleled root-cause analysis of unstructured medical records
- – Deep insights into the causes of billing errors
Improving Cash Flows by Advancing PI Recovery Collections of $15-20 Million Every Month
Sagility helped a leading payer significantly increase their ability to recoup overpayments, resulting in improved cash flow collections by more than $30 million annually.