Optimize Claims Processing with PCH Health's Payment Integrity

Harness expert guidance for enhanced payment efficiency and precision

Leveraging advanced technology and a team of subject matter experts, PCH Health eliminates unnecessary additional processing, cutting down on claims processing costs and time, often inflated by reprocessing due to discrepancies with providers.

Our comprehensive payment integrity approach addresses payment issues through pre-submission edits, prepayment adjustments, audits, collaboration portals, and analytics.

Pre-submission edits

Smart edit engine, including Proprietary Edits, SNIP, Clinical, and Billing Edits tailored for EDI and paper claims. Review and correct errors before submission, boosting clean claim rate.

Pre-and-post-payment edits

An automated process providing a seamless workflow for requesting additional review records featuring Clinical Edits, Utilization Edits, Historical Edits, and more.

Overpayment identification and recovery

Concurrent and retrospective review and recovery of funds. Root cause analysis to identify and rectify systemic issues, preventing recurrent inaccurate payments.

Analytics and healthcare FWA (Fraud, Waste, and Abuse) and medical coding

AI-powered reporting and dashboard, providing immediate alters and insightful root cause analysis. Medical coding and audit ensure accuracy and compliance in every claim.

Why PCH Health?

With state-of-the-art technologies and a team of subject matter experts, PCH Health's payment integrity solution is designed to streamline claims processing, minimize errors, and foster trust between payers and providers.

Our payment integrity solutions optimize revenue and improve compliance by ensuring accurate payments, reduced processing time, and enhanced efficiency.

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