Provider Billing & Coding

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Depending on the health plan’s ability to quickly transfer and receive data, Performant Healthcare Solutions offers both pre- and post-payment data mining solutions. We leverage proprietary algorithms to help identify overpayments post-payment and proactive membership and group management to prevent overpayments related to eligibility and COB pre-payment. These algorithms target professional, inpatient, and outpatient claims within the areas of contractual, duplicate, and industry standard reductions and regulations.

We offer health plans flexible data mining solutions designed to alleviate the health plan’s resource constraints. Plans can either approve algorithms on the front end to immediately move identified errors directly to pre-pay repricing or post-payment recovery or elect to receive a findings file detailing all identified claims and then approve or deny claims individually.

Complete membership management, or a focus on pre-payment or post-payment, can be conducted by proactively managing life events (e.g., retirement or long-term disability leaves) and changes in group sizes above and below applicable CMS thresholds. Performant can then recover identifications on claims due to retro-termination or where the client pays primary for services where only secondary or tertiary liability should have been paid.