The engine for claims review, analysis, and recovery.
Even if your plan has improperly paid claims, it’s not too late!
Scan every single claim for the past 3-years and monitors claims going forward.
Using more than 3 million industry-standard rules coupled with hundreds of proprietary algorithms the platform automates the process to identify claims for overbilling and potential fraud.
Billing & Coding 37%
Contracted Rates 25%
Payment Guidelines 18%
Fraud, Waste & Abuse 11%
Episode of Care 6%
Summary Plan Description 3%
Certified Medical Coders reprocess claims with providers to deliver money-back to the plan and families.
No member involvement, ever!
DRG 269-4 Maj Pancreas & Liver K72.91 Hepatic Failure, unspecified with Coma
DRG 269-3 Maj Pancreas & Liver K72.90 Hepatic Failure, unspecified without Coma
Hospital mischaracterized the condition of a patient as comatose, when the patient was not, costing the company significantly.
2% of the claims are returned in the first quarter. The entire recovery process takes 6-9 months.
FREE CLAIMS RECOVERY ASSESSMENT
Through our engagement with our partners, Klaims AI will review every single claim to ensure billing and pricing
accuracy. This process can decreases your plan’s healthcare spend by 10%-25%.
100% of medical
claims reviewed.
5% – 15% recovered.
5X industry average.
