Incrementalism Is The Enemy.

Health Plan Performance Suite

Optimize operations, compliance, care management, and payment performance while dynamically controlling operating costs.

An integrated suite of Integr8 AI-powered engines and applications enabling health plans to break away from costly and labor-intensive episodic processes, decades-old claims systems, and latent care management models that increase provider abrasion and compromise member health.

Predictive FORM* Plan Design

Adaptive Claims Management

Dynamic Care Management

N
Prior authorization management
N
Live POC benefits verification
N
Continuous med and Rx care gap detection and intervention management
N
Bi-directional claims monitoring and EHR integration

Claims-Based Risk Adjustment

N
Continuous care gap and risk benchmarking
N
Automated outcome improvement and non-action models
N
Continuous care gap surveillance, detection, alerts and risk adjustment

An integrated suite of patented, Integr8 AI-powered engines and applications focused on solving challenges caused by disconnected network, payment integrity, and SIU functions: 1) chronic provider data inaccuracy and management costs, 2) siloed payment integrity that can’t see provider behaviors and misses the mark on prevention, and 3) overloaded and inefficient SIUs dependent on manual investigations.

Automated Provider Network Management

N
Continuous provider data management
N
Continuous provider billing behavior analysis
N
Continuous credentialing & attestation

Provider-Centric Payment Integrity

N
Continuous medical & pharmacy FWA prevention
N
Real-time pre-service order integrity (DME, Pharmacy, Lab Services, NEMT, Medical Imaging, etc.)
N
Provider Integrity Edits
N
Adaptive Claims Edits
N
Continuous billing behavior analysis
N
Continuous schemes detection & analysis

Automated SIU Investigation & Management

N
Rapid FWA prevention and offset detection
N
FWA lead generation & management
N
Agentic Investig8 AI™ Agents for automated first-line investigation
N
Continuous post-payment claims and provider audit

An integrated suite of patented, Integr8 AI-powered engines and applications focused on solving major compliance, supply chain, utilization and pricing challenges and gaps that are common across plans of all sizes, but most acute in mid-size and smaller commercial plans, self-insured, and workers comp plans that are dependent on external PBMs.

Rx Supply Chain Compliance & Management

Rx Utilization, Safety & Care Management

N
Conventional, specialty, compounding, and OTC
N
Formulary management
N
Rebate management
N
Utilization and therapy management
N
Cost containment analytics

Rx Pricing Integrity & Management

N
Value and evidence-based cost containment
N
Dynamic claim-by-claim detection of pricing, planand member risk
N
Continuous pricing integrity analysis
N
Early operational threat detection and alerts