Start paying professional claims the right way.
Stop fraud, boost accuracy and save money.
PhysicianClaim Insight® is a prepayment fraud, abuse and overpayment prevention service. It’s designed to help you maximize claims payment accuracy, identify fraudulent providers and reduce professional claims costs. By combining our advanced Code Validator Pro® (rules-based) and Fraud Finder Pro® (profiling) software systems, you get access to better technology. By relying on experienced clinicians and investigators for claim and provider validation, you get better results.
We have experienced positive changed in provider billing habits resulting in significant savings Mary Alice Garcia, BA, CPC Medicaid MCO
The Problem
An estimated 3% -10% of physician and clinical care expenses are lost to fraud, abuse and overpayments annually. By 2013, losses could surpass $63 billion. That's a loss of over $172 million daily.
The Solution
Pay Right. Save Money
Reduce expenditures up to $4 PMPM. Increase profits and payment accuracy.
Get a Nurse. Get Results.
Our clinical validation process delivers less false positives and better results.
Save Time. Go Prepayment.
Avoid “pay and chase” detection with prepayment analysis on 100% of claims.
Smart Models. Smarter Software.
Get access to the most advanced fraud models and SaaS applications available.
Better Support. Better Service.
Get help from licensed nurses and coders. Get appeals support, reporting and more.
Total Customization. Totally You.
No two payors are alike. Customize your fraud solution down to the last bit and byte.
Real Fast, Real-Time Processing.
You don’t have time to hold up processing. Get real-time protection with real results.
Fraud and Editing. All in One.
Unilke others, we bundle supplemental editing and fraud prevention in one solution.
View PCI Brochure
Want more information? View and download the PCI service brochure.
Read Success Stories
Still need convincing? Read and download customer case studies and testimonials.
Watch Videos
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Request Free Trial
Ready to take the next step? Request a free PCI trial and Cost Reduction Analysis.
