OUR SOLUTIONS
Powerful payment integrity solutions
Streamline your entire healthcare payment process with proven accuracy, transparency, and industry-defining flexibility.
OUR IMPACT
Outpacing complexity.
Unlocking value.
Every business needs a unique combination of people, resources, and healthcare technology behind its payment processes. We’re here to curate it for you.
Our configurable, content-rich AI-enabled platform—combined with our deep subject-matter expertise—enables us to deliver tailored solutions to 60 health plan clients. With billions in annual cost savings and avoidance, we consistently achieve unmatched results through our unwavering commitment to client service and quality.
HOW IT WORKS
Comprehensive meets specialized
We create configurable solutions that streamline workflows and uncover actionable insights with unmatched speed and accuracy. By shifting your payment integrity process left—from post-pay to pre-pay—we’ll help you prevent claim inaccuracies and fuel stronger financial results.
Platform-powered capabilities
From Complex Payment to Right Payer Solutions, we offer best-in-class capabilities across the payment continuum to solve your unique challenges. At the center of it all, our powerful Healthcare Intelligence Platform drives greater efficiency and accuracy across everything we do.
Complex Payment Solutions
With specialized analytic models and tech-driven solutions, we can achieve up to 90% automation and a 50% yield improvement. We offer configurable SaaS solutions developed for APC and DRG codes and more to improve accuracy and speed across payment integrity processes and reduce billing errors.
• Clinical and Coding Validation
• Itemized Billing (IBR) and Compliance Review
• Specialty Solutions
Data Mining Solutions
Machinify’s AI has learned “the language of medical coding” by digesting and enforcing payment policies and contracts, ensuring accurate coding and pricing of all claims at wire-speed.
• Payment Policy Enforcement
• Coding, Billing, and Pricing Edits
• Claim Repricing
Right Payer Solutions
Our team of specialists set the industry standard in subrogation, coordination of benefits, mass tort, and workers’ compensation. We’re always anticipating industry shifts and harnessing our unmatched expertise—from over 850 specialized analysts and 55 licensed attorneys—to facilitate efficient healthcare reimbursements and recover more money for our clients.
• Medical Coordination of Benefits (COB)
• Workers’ Compensation
• Subrogation
Pharmacy Payment Solutions
We leverage AI insights and precise algorithms to reduce drug and health errors, increase paid claims accuracy, and avoid overpayments for maximum cost containment. With over 90 specialized pharmacy payment analysts and a 12-year average client tenure, we bring unique and trusted expertise to the category.
• Pharmacy Coordination of Benefits (COB)
• Medical Pharmacy Benefits
• High Cost/Specialty Drug Management
What sets our platform apart
Partner with us
Let’s put innovative capabilities to work in your payment integrity processes. We’ll help you design the right offerings for your business—and optimize their value at every step of the way.
OUR PERSPECTIVE
Decisive insights from
leading experts
Explore news, guidance, case studies, and best practices, like automating the input of service codes for medical billing to reduce healthcare costs, increase efficiency and transparency, and more.
