Control Medical Costs with Data-Driven Payment Integrity
Medical and economic forces are shifting fast, and your cost controls need to keep pace. We combine industry-leading data, technology, and expertise to deliver payment integrity customized to your book of business at scale, ensuring every bill is accurate, compliant, and aligned to medical necessity. Our integrated approach helps you control rising medical costs while maintaining strong provider relationships and supporting quality care. From intelligent routing to clinical validation and contract optimization, we deliver accurate results with less administrative complexity for your claims teams. When the cost landscape shifts, we help you respond with confidence.
Medical Bill Review
Achieve true payment integrity with comprehensive Medical Bill Review that blends advanced rules, current accurate and timely fee schedules, clinical validation, and configurable coding logic across multiple platforms. We tailor edits and escalation paths to your specific strategy, catching anomalies and inappropriate charges while protecting clinical appropriateness and compliance. Integrated utilization signals and guideline checks ensure the right care at the right cost, before errors become overpayments. Seamless connections to leading claim systems and EDI keep workflows moving smoothly and reduce noise for your adjusters. That means you see fewer leakage points, more accurate allowances, and measurable savings you can track and validate.
Networks & Negotiations
Our network strategy and out-of-network negotiations offer strategic cost control that doesn’t compromise relationships. Working seamlessly with OnPath’s intelligent routing, it captures predictable discounts and eliminates leakage. We build a data-driven “mosaic” by service type, optimizing PPO stacks, directing bills to the most cost-effective paths, and deploying specialty solutions where they deliver significant value. Our expert negotiators and provider relations team secure competitive rates while reducing administrative friction and maintaining strong partnerships.
OnPath
OnPath is the intelligence layer that systemically orchestrates payment integrity across your entire bill processing operation, using advanced analytics to route each bill to the optimal combination of contracts, fee schedules, clinical checks, negotiations, and specialty reviews. Rather than reacting bill by bill, OnPath continuously analyzes program performance and maintains a proactive routing strategy that’s ready before the next bill arrives. The result is fewer overpayments, lower variance, and less friction for providers and adjusters, all without sacrificing compliance or clinical appropriateness.
