Performant offers technology-driven audit, recovery and analytics solutions to health plans, partnering with government and commercial plans to navigate the complex regulatory landscape and help reduce healthcare payment losses. Our suite of payment integrity, eligibility and recovery solutions leverage:
- Subject matter expertise in healthcare coding, policy and billing requirements, coordination of benefits and improper payment resolution, including pre- and post-payment audit, cost avoidance, premium restoration and compliance reporting
- Program integrity risk assessments, error detection and trend analysis
- Logic and algorithms to analyze large data sets and produce meaningful outcomes
- Dedicated lockbox services offering complete end-to-end processing and accounting
- Integrating optical character recognition (OCR) to scan and digitize documents received by mail, maintaining a detailed account record
- Efficient methods to detect fraud, waste and abuse and improper payments, including claims analysis, appeals management and recovery of improper payments
- Handling, analyzing, storing and transmitting large volumes of data
- Understanding control systems and weaknesses
- Conducting project administration and management
Performant’s business model is difficult to replicate, as it incorporates a combination of several important and differentiated elements, including:
INNOVATION
Performant offers superior alignment to our customers. Every Health Plan is unique and many of our customers come to Performant seeking solutions for their important challenges. With Performant’s proprietary data system and workbench platform, we are tirelessly dedicated to the development of solutions to support our customer’s needs, freeing them to focus on their core mission.
INDEPENDENCE
Performant is one of a very small number of payment integrity firms not owned or associated with major payers, which allows us to operate autonomously, singularly focused on the needs of our customers – not a complex bureaucracy of competing interests.
FLEXIBILITY
Adaptability in the changing medical and payment integrity markets is key, especially in a post COVID-19 environment. Our nimbleness and ability allow Performant to rapidly transform to meet market needs, such as offering novel savings ideas to help plans compensate for COVID-19 losses.
EXPERTISE
Performant has attracted the best and brightest in the industry to find the root causes of savings leakage and deliver effective solutions with finesse.
TRANSPARENCY
Unlike many vendors, Performant is willing to pull back the curtain with both our customers and business partners – we believe a collective understanding of the “why” is critical for collaborative success.