In 2022, National Health Expenditure Data revealed that commercial healthcare plans raised total claim spending to $1.3 trillion annually. On average, healthcare payers experience a claim payment error rate of 6% of total spending, resulting in about $77 billion being overpaid each year. Of this amount, 30% to 50% is due to contract compliance issues, translating to approximately $23 billion to $38 billion in claim overpayments annually. At Forensic Claims Solutions, we simplify complex contract compliance audits by utilizing our proprietary technology platform Sleuth© to predictively price every contract term for every participating provider in your network.
Simplify, Analyze, Recover
Sleuth is the industry’s only predictive pricing platform for commercial, self-funded and government lines of business.
Contract Compliance Leakage
For insurers looking to identify contract compliance leakage, our product Sleuth© will detect contract terms for your entire participating provider network. Using this information we pinpoint payment errors quickly and efficiently while working with you to stop them from happening in the future.
Audit Concept Ideation
Our top-tier concept library can quickly enhance your outcomes. We offer whitepapers and supporting materials for each concept, and the library is expanding daily. Last year, these concepts helped our clients generate over $50 million.
Inpatient / Outpatient Chart Selection Service
Our cutting-edge analytics engine identifies claims with a high likelihood of recovery by focusing on metrics that signal coding errors. It uncovers valuable insights into miscoded claims, including diagnostic combinations along with multiple comorbidities and the length of stay for medical and surgical DRGs. From an outpatient viewpoint, our algorithms detect instances of up-coded surgeries and incorrect carveouts for implantable devices.
Strategic Consulting
We enable stakeholders to improve payment integrity by simplifying processes, minimizing provider abrasion, and increasing claim payment accuracy. Our approach combines unique insights and analytical solutions, supported by extensive healthcare expertise, proprietary data, and a state-of-the-art technology platform.
What our clients say
Our Success
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In Overpayments
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Contract Claims
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Audit Concepts
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Contact Us
(502)-649-2065
Louisville, KY