In today’s value-based care environment, payors and providers are exploring innovative partnerships to work in lockstep to achieve best patient outcomes, at low cost while maintaining high quality. This is easier said than done, when the payor-provider relationship is often stressful and the goals arent properly aligned.
HOAP Health empowers payors with powerful analytical tools that can aggregate the claims data and analyze it myriad ways – by provider, service line, region, demographics, health plans, pharmacy, revenue code, procedure etc. HOAP Health’s AI driven algorithms give payors insight on the accuracy of claims while searching for hidden patterns of aggressive coding, mis-coding, over charges, wrong charges or fraudulent charges. Once data anomalies are identified, HOAP flags the “suspect” claims to take corrective actions before claims are reimbursed.
HOAP Health’s Payor Provider Analytics gives actionable data-driven insight on claims and reimbursements across all providers, distinguishes leaders vs underperformers, flags suspect claims, improves accuracy in remits and health plans viability.