Cost containment

Peace of mind about payments

Containing costs and identifying waste can feel like a constant struggle. Personify Health relieves the hassle with a better approach. Our lowered allowed costs are 19%—averaging $82.48 per employee per month (PEPM). Our solutions ensure fairness, accuracy, and responsibility for claims and payment. We work to preauthorize procedures correctly, identify incorrect or suspect payments and provider coding mistakes, and resolve issues promptly.

How it works

More accurate payments and claims

You deserve great service, so we’ve really focused on handling claims quickly and fairly. Firstly, our claims accuracy rate is 99.7%. All claims over $25K are audited for accuracy (but the audit amount can be adjusted for your needs). And with 63% of claims processed within 24 hours, we don’t keep you waiting. The result? We save three times the industry average on claims duplicates, with a $44 PEPM overall for claims adjudication. And with our post-payment assessment, our data-driven analytics can also identify discrepancies or possible fraud even after payment is made—and recover funds quickly and fairly. 

How we help

Avoiding fraud and waste

We check all the numbers for you—for fraud, for effectiveness, and for overpayment. Personify’s payment integrity programs assure claims accuracy and quickly detect fraud. Review teams confirm the medical necessity of procedures and can suggest more cost-effective approaches while maintaining quality care. And even on low-payment claims, AI-driven assessments will unearth fraud or abuse because every claim adds up. Don’t worry—if overpayment does occur; our expert recovery process gets funds returned to you quickly and efficiently.

90%

of savings captured pre-pay

Advocating for you

Personify is always at your side to protect your interests and find savings for you and your members. For example, our dialysis management process ensures that a Medicare patient is enrolled, covered, and receives benefits at the allowable amount, and results in both the patient owing nothing and an 80% average savings on dialysis claims. Our subrogation process protects you at the negotiating table when another entity is responsible for payment. And our out-of-network (OON) negotiations use a comprehensive process to leverage historical data, contain costs, and shield you from further billing or appeals. We’re your advocate, every step of the way.

54%

discount for OON

Rethinking recovery

Our commitment to you: we deal with the hassle if an overpayment occurs. Our recovery process, including 35 automated and manual steps, is designed to quickly identify payment errors. Our post-payment, AI-powered data analysis uncovers possible issues (and determines where and why they happened), and our recovery team promptly resolves errors and gets you restitution.

$20

average PEPM saved

Request a demo of our personalized health platform 

Explore our other solutions

Personify’s personalized health platform offers you a full stack of solutions to optimize benefits and inspire people to engage more fully with their health.

Blogs and success stories

Discover more about personalized healthcare

Success story

Corteva’s Próspera Global Wellness Program Gives Employees a New Lease on Life