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Strengthen Payment Accuracy with AI for Enhanced Financial Integrity
Minimize payment leakage for payers by unifying pre-payment, post-payment, fraud detection, coding, and contract compliance under one intelligence layer. Detect and prevent risky claims before they reach adjudication, using artificial intelligence (AI) and policy-driven rules. Streamline operations with precise risk scoring, fewer false positives, and faster, more accurate decisions. Integrate seamlessly with core systems to keep operations moving without disruption. Recover revenue at scale while reducing process delay and ensuring full compliance visibility.
Learn What NewgenONE Payment Integrity Solution Can Do for You
Screen Claims with AI-driven Pre-payment Controls
Validate coding, medical necessity, and contract compliance the moment a claim enters workflow. Flag inconsistencies early with AI and a configurable rules engine, keeping invalid submissions out of the payment cycle.
Detect Fraud, Waste, and Abuse in Real-time
Monitor provider behavior and billing patterns as they happen. Surface high-risk activity instantly. Cut fraudulent payouts, protect plan assets, and cut the investigation backlog.
Recover Overpayments Automatically
Audit claims, reconcile provider activity, and track outstanding amounts with full visibility. Recover erroneous payouts and close financial gaps that manual reviews often miss.
Score Fraud Risk Dynamically
Analyze context, provider history, and behavior to assign every claim a real-time risk score. Route high-risk cases for immediate review.
Route Exceptions with Intelligent Case Management
Send flagged claims to investigators, clinical reviewers, or fraud teams based on severity and complexity. Cut turnaround time, reduce handoffs, and keep tight oversight without loading teams.
Integrate Systems Seamlessly
Connect to core admin platforms, EHRs, policy engines, and adjudication systems effortlessly. Deploy modular components quickly and scale as needed, maintaining smooth operations.
Screen Claims with AI-driven Pre-payment Controls
Validate coding, medical necessity, and contract compliance the moment a claim enters workflow. Flag inconsistencies early with AI and a configurable rules engine, keeping invalid submissions out of the payment cycle.
Detect Fraud, Waste, and Abuse in Real-time
Monitor provider behavior and billing patterns as they happen. Surface high-risk activity instantly. Cut fraudulent payouts, protect plan assets, and cut the investigation backlog.
Recover Overpayments Automatically
Audit claims, reconcile provider activity, and track outstanding amounts with full visibility. Recover erroneous payouts and close financial gaps that manual reviews often miss.
Score Fraud Risk Dynamically
Analyze context, provider history, and behavior to assign every claim a real-time risk score. Route high-risk cases for immediate review.
Route Exceptions with Intelligent Case Management
Send flagged claims to investigators, clinical reviewers, or fraud teams based on severity and complexity. Cut turnaround time, reduce handoffs, and keep tight oversight without loading teams.
Integrate Systems Seamlessly
Connect to core admin platforms, EHRs, policy engines, and adjudication systems effortlessly. Deploy modular components quickly and scale as needed, maintaining smooth operations.
Key Benefits
- Prevent payment leakage before funds are released
- Reduce fraudulent claims and suspicious patterns
- Accelerate claims processing with intelligent automation
- Cut manual review volumes and repetitive rework
- Increase recovery of erroneous payments
- Strengthen compliance through complete audit trails
- Minimize disputes and enhance provider relations
Explore Other Solutions for the Payer-Provider Journey
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Schedule a Demo to See NewgenONE Payment Integrity Solution in Action
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