PrecisionGx helps commercial, Medicare Advantage and Managed Care plans optimize payment accuracy, improve risk adjustment auditing and reduce the administrative burden through automated premium and payment integrity solutions.
Coordination of benefits
Our Engine can more precisely identify which patients have alternative primary coverage, allowing us to better distinguish recoverable from non-recoverable claims the day they’re received and accurately flag the right claims the first time, helping to maximize recoveries while significantly reducing recovery efforts and costs.
Our Engine takes a deep dive into provider behaviors and billing patterns by simultaneously mapping millions of relationships across thousands of dimensions. Through this process we’re able to identify overpayments that go beyond existing detection capabilities, generating millions of dollars in potential savings every year by reducing unnecessary auditing and optimizing the recovery process.
Risk adjustment auditing
Our Engine helps plans offset the cost of providing coverage to high-risk groups by accurately identifying any gaps or missing information within the claims and correctly determining the true health status of targeted members, improving risk scoring and reducing unnecessary chart audits with >99% recall.