Pioneering the Future of Payment Integrity

Where healthcare expertise meets innovative technology to transform payment integrity

About Us

Extensive experience in the health insurance industry with a specialization in Payment Integrity Solutions

Our Expertise

We have extensive experience in the health insurance industry with a specialization in Payment Integrity Solutions. Our experience includes post and pre-pay savings as well as revenue maximization for Commercial, ACA, Medicare Advantage and Medicaid clients.

360 Feedback Loop

  • Quality Improvement
  • Call Center and Dispute Support
  • Less than 5% overturn rate
  • Post-pay Recovery migration to Pre-pay Avoidance

Proven Results

$12-$55 PMPY
Incremental Savings
20M+
Members Served
4 Direct Clients and 6 Indirect Clients
$250M+
Identified in Last 12 Months
Overpayment Recovery

Baseline for Health Plans

Mature Payment Integrity Departments should experience the following as a percentage of medical expense savings:

12%

Medicaid

Due to larger percentage of members with other insurance (COB)

6%

Medicare

With opportunity for revenue maximization from risk adjustment and ESRD

6%

ACA & Commercial

Based on Provider Contract Agreements and Payment Policies

Our Services

Full service or subscription-based AI applications and consultative services

AI Applications

Full service or lease options available

  • Clinical Review
  • Data Mining Ideation
  • ESRD and Hospice Premium
  • Facility ER Leveling

Consultative Services

Expert guidance and support

  • Payment Integrity Best Practices
  • White Papers, Policies and Ideation
  • Quality Improvement
  • Business Case Support and Strategy
  • Financial Accrual and Reconciliation
  • Data Repository and Metrics

Safeguards

Enterprise security and compliance

  • Cyber Security Insurance
  • Cloud Based (SOC 1 and 2)
  • First Tier, Downstream, Related Entity (FDR) Ready

Company Metrics

Our growth and impact measured in numbers

0
Health Plan Clients
0
Members Served
0
Direct and Indirect Clients

Get In Touch

Connect with our experts to discover how Advice Healthcare can help you achieve your goals

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Schedule a Demo

See our platform in action with a personalized demonstration tailored to your organization's needs.

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Receive a custom analysis of your potential savings and ROI with our solutions.

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Contact Us

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Client Support

Existing clients can access 24/7 support through our dedicated portal.

Email: support@advicehealthcare.com

Access Support Portal

Partner Portal

Access partner resources, documentation, and collaboration tools.

Email: partners@advicehealthcare.com

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