Ensure 360° precision touch at all points of the value chain.
The healthcare ecosystem
The complexities of claims
Payer and provider
Certified clinical and coding
resources, at scale
Sagility’s Precision Payment Integrity has achieved dramatic results for payers through an analytics- and clinical expertise-led cognitive approach spanning pre-pay and post-pay solutions. Our results include annual savings for our clients of $973 million in prepay and $777 million in post-pay.
with a 360-degree approach of end-to-end processes, for exponential return.
Datamining type of reviews require precise selection of claims using analytics and algorithms to validate the claims are paid as per benefit policies, provider contracts, reimbursement guidelines. These audits are performed by claims analysts and auditors. AI and data analytics play vital role to identify the aberrant claims for review.
These audit types are classified by provider type and place of service. These require medical records review for the claims selected for audits. The claims are reviewed by licensed nurses, physicians, and certified coders for billing accuracy of the provider based on medical record review. These are more complex audits that require skilled resources.
Sagility can conduct randomized, targeted, and follow-up diagnosis-related group reimbursement (DRG) audits. Proactively or reactively, we work diligently on your behalf to ensure that codes are assigned accurately for each DRG.
Our DRG specialists and software can validate codes using physician documentation, nursing notes, lab/imaging results, medications, surgical reports, therapist notes, and more.
By effectively combining Claris Health’s payment integrity technology with Sagility’s in-house PI resources, we take aim at recoupments according to payment risk while reducing costs and provider strain.
Sagility Payment Integrity solutions are based on your needs and preferences. We deliver our end-to-end solution via different engagement models: full outsourced managed service model or as an extension to your internal PI team and as a true partner.
Boost internal analyst productivity
Implement an entire clinical document request strategy from a single platform
Build a solid CMS strategy to “pay it right.”