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Resources & Success Stories

Explore real-world case studies, expert insights, and educational resources

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Customer Success Stories

See how leading healthcare organizations achieve measurable results with Advice Healthcare

National payer case study
Commercial Plans

Large National Payer

Client Profile

  • 15 million members
  • $50B annual claims spend
  • 500,000 providers

Challenge

Manual review processes causing payment delays and high operational costs while missing significant improper payments.

Solution

Implemented full-spectrum pre and post-pay solutions with AI-powered automation.

Results

42%
Reduction in Payment Errors
$450M
Annual Savings
3-day
Faster Payment Cycles
85%
Provider Satisfaction
Medicare Advantage case study
Medicare Advantage

Regional Medicare Advantage Plan

Client Profile

  • 500,000 Medicare members
  • $5B annual spend
  • Focus on quality measures

Challenge

Struggling with CMS compliance while managing rising costs and complex chronic conditions.

Solution

Deployed clinical validation with focus on DRG accuracy and quality measure alignment.

Results

5-star
CMS Rating Achieved
$75M
Recovered First Year
98%
Audit Success Rate
30%
Reduction in Readmissions
Medicaid MCO case study
Medicaid Managed Care

Multi-State Medicaid MCO

Client Profile

  • 3 million Medicaid members
  • Complex population health needs
  • Value-based contracts

Challenge

High-risk population with significant fraud, waste, and abuse concerns.

Solution

Comprehensive pre and post-pay data mining with advanced pattern recognition.

Results

$120M
FWA Savings
92%
Accurate Payments
6:1
ROI First Year
100%
State Audit Pass
Self-funded employer case study
Self-Funded

Fortune 500 Self-Funded Employer

Client Profile

  • 100,000 employees and dependents
  • High-cost claimants
  • Multiple TPA relationships

Challenge

Rising healthcare costs with limited visibility into payment accuracy across TPAs.

Solution

Implemented post-pay recovery with high-dollar claim validation and TPA oversight.

Results

$15M
Recovered in 18 Months
35%
Cost Trend Reduction
Zero
Disruption to Members
90%
Employee Satisfaction

Educational Webinars

Learn from industry experts about the latest trends and best practices in payment integrity

Upcoming Webinars

Maximizing ROI with Pre-Pay Solutions

Learn how to implement effective pre-payment strategies that deliver maximum value and reduce downstream costs.

Date: November 15, 2024

2025 Payment Integrity Predictions

Join our experts as they share insights on emerging trends and regulatory changes for the coming year.

Date: December 5, 2024

On-Demand Webinars

Getting Started with AI-Powered Payment Integrity

Learn the fundamentals of implementing AI-powered payment integrity solutions in your organization.

Building a Best-in-Class Clinical Validation Program

Expert guidance on establishing and scaling clinical validation operations for optimal outcomes.

Industry Reports

Comprehensive research and analysis to inform your payment integrity strategy

Quarterly Payment Integrity Trends

In-depth analysis of emerging trends, regulatory changes, and technological innovations shaping the payment integrity landscape. Each quarterly report provides actionable insights for strategic planning and operational improvements.

Annual Fraud & Abuse Report

Comprehensive analysis of fraud patterns, emerging threats, and prevention strategies. Based on analysis of billions of claims, this report provides critical intelligence for protecting your organization from financial losses.

Technology Innovation Index

Assessment of emerging technologies and their impact on payment integrity operations. This report evaluates AI advancements, automation tools, and digital transformation trends to help you stay ahead of the curve.

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Access expert insights and cutting-edge research to drive your payment integrity strategy forward

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