Payment integrity

Cost management that gives you peace of mind

Containing costs can feel like a constant struggle. Personify Health relieves the hassle with benefits administration and offers better care management that brings peace of mind. On average, plans have 23% lowered allowed costs for groups that elect clinical programs, averaging $63.58 per employee per month (PEPM). We work where you need us to preauthorize procedures correctly, identify incorrect or suspect payments and provider coding mistakes, resolve issues promptly, and so much more to make sure you receive the best cost savings with the best outcomes.

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How it works

More accurate payments and claims

We start with claims accuracy and payment integrity to streamline healthcare spending. Our process includes both automated and manual audits during every step in the life of a claim. In this way, 100% of claims are checked multiple times. Our transparent approach includes fee negotiation, subrogation, and eligibility audits—all driven by our analytics and insights. We carefully assess claim accuracy and reimbursement eligibility with a rapid turnaround while quickly detecting fraud and abuse.

Paired with best-in-class Care Management designed to improve member outcomes, reduce healthcare costs, and enhance member satisfaction. It is a proactive and patient-centered approach to managing member health that helps improve health outcomes, reduce hospitalizations, and lower healthcare costs.

How we help

Avoiding fraud, waste, and abuse 

Our aggressive and thorough payment integrity program employs an exhaustive set of processes, a continuously updated library of fraud schemes, integrated technologies, deep expertise, and best-of-breed partnerships—all to protect you. Our processes include both automated and manual audits during every set in the life of a claim. Automated AI-driven claims scoring with in-house clinical auditing makes a powerful combination—ensuring 100% of claims are checked multiple times. And each scheme has multiple passes to be identified and resolved.

$11.8M

saved in paid claim amounts

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.

48%

lower inpatient costs

Rethinking recovery

Our commitment to you: we deal with the hassle if an overpayment occurs. Our 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.

$3,916

average savings per flagged claim

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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.