Healthcare Payment Integrity Solutions

Alivia Analytics is the most inclusive payment integrity partner in the healthcare industry for commercial and government health plans. Our tech-enabled services and SaaS identify new recoveries missed by legacy vendors, deliver actionable pre- and post-pay analytics, and offer automated pre-pay corrections.

Our first-pass pre-payment editing capabilities easily append claim errors for clinical coding – preventing and stopping erroneous billing. Alivia’s technology and robust content seamlessly integrate with your existing claims adjudication and payment workflows using healthcare rules, regulations, and policies.

We coordinate benefits for two or more health plans, paying their share for the care. Alivia runs models determining potential members with other coverage (Commercial Carriers + Medicare), identify members with additional coverage, secondary, tertiary, etc., and submit member information and claims needed for reclamation or recoveries.

We flag and pause suspect claims in real-time, requesting medical records from providers. Focus areas include DRG Audits, Compliance, Documentation Adequacy, Medical Necessity, QMS Compliance, Device Classifications & Listings, Charge Accuracy, Itemization & Transparency.

We identify inappropriate payments leveraging our AI engine and payment integrity industry experts. Other vendors provide legacy business rule catalogs, costly labor models, manual and error-prone analysis, fewer recoveries and high overhead, and low confidence and high cost.