PAYER SOLUTIONS

Payment Accuracy

Reduce administrative and claim costs and increase payment accuracy through industry-leading technology.

Get better results, new concepts, automated intelligence

Our Payment Accuracy solution leverages AI technology and data analytics to efficiently identify, recover, and prevent overpayments, while also offering expert analysis to identify potential overpayments, root cause reporting, and mitigation opportunities for clients. With fully validated results and flexible service delivery models, our solution seamlessly integrates with existing programs, contributing to incremental savings for our clients.

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Net new recoveries in month one

AI audits faster than manual audits

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Accuracy rates based on validated results

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Average reduction in administrative expenses

Let’s talk about Payer Challenges

CASE STUDY

Payment Accuracy

Plan Overview

Single-state BCBS Plan
Number of Members: ~3 Million Lives

Key Value Drivers

6 months in production
Health plan finds TREND’s workflow/reporting easy to use
Claims go from identified to retracted savings in 9 days
Reduced the health plans’ time to support by 45%
65% increase in Gross Recoveries
320% increase in average claim recovery
98% accuracy rates achieved

Annualized Recoveries

PAYMENT ACCURACY

TREND’s comprehensive and integrated Payment Accuracy solution + PrecisionGx’s leading AI Engine

More Recoveries, Faster to Results
  • +16% recoveries in one month
  • +65% recoveries in 2nd pass, +27% in 3rd pass in six months
  • 98% human accuracy rate, 96% AI accuracy in automations
AI Built for Payment Accuracy
  • >80% automation in areas of interest for insourcing/prepay
  • ~30% reduction in reliance on vendors in COB
  • AI audits 26x faster, 97% reduction in cost where automated

Getting started with our AI powered Data Mining or with Payment Accuracy Intelligence only

Bring us in for Data Mining
  • Add net new recoveries within months, early or late pass
  • Identify new concepts, content across claim types, lines of business
  • Add the benefits of Payment Accuracy Intelligence below
Start with Payment Accuracy Intelligence only
  • Get case hits with AI scoring and/or full AI audit results
  • Uncover new content/concepts, underserviced areas
  • Discover automation opportunities for admin. savings and better internal performance

Get better results, new concepts, automated intelligence

Membership Integrity

Accurately identify members with unknown Medicare coverage whether or not they have claims.

Break Out of Traditional COB
  • Avoid vendors holding on to coverage changes until large claims come in
  • Minimize reliance on COB vendors overall
  • Reduce fees
  • Prevent future COB
  • Eliminate abrasion associated with post-pay COB

Getting started with Membership Integrity on its own or add COB Data Mining support

Membership Integrity
  • Use typical claims data feed from plan
  • Receive identified Medicare members with direct CMS information
  • Pass to internal team to update, validate recoveries and generate results
Add to COB Data Mining
  • Add validation, primacy determination, and COB services to generate recoveries.
  • Add to existing Data Mining implementation seamlessly

Get better results, new concepts, automated intelligence

What makes TREND Different?

Monthly Status Report

Details your claim inventory status, providing a claim roll-up of the activity taken on the claims, where they currently reside in the process, and final claim resolution.

Executive Summary

Overviews metrics for designated period and may show trends not easily seen within the project. Helps escalate any issues or opportunities for both TREND and client.

On-Trend Report

Case-by-case review to determine appeal opportunities. Aggregates and outlines the story of your denials plus our recommendations for addressing root causes.

Infographic Reporting

Illustratively depicts claims appealed and recovery results. Specific graphs can include appealed amounts by payer and/or denial type plus closures by reasons and/or payers.