Payment Integrity (PI) Rules library, ideation and concepts development enabled through a next-gen SaaS platform solution, to enhance savings for Health Plans

JACKSONVILLE, FL, USA, May 5, 2023/EINPresswire.com/ -- CoverSelf Inc., a Healthcare Technology company, specializing in next-gen, cloud-native, open & customizable claims accuracy platform with an integrated & customizable workflow and data warehouse, and Paytegrity LLC, an innovative, Payment Integrity (PI) ideation company with an extensive library of customizable detection solutions, designed to support Payors with in-house deployment of prepayment algorithms announced that they have formed a strategic partnership to offer next gen overpayment detection to Health Plans and Partners. The combined offering of thousands of rules coupled with a very powerful automated configurable & highly scalable engine is designed to process claims in real-time to identify overpayments and drive greater cost avoidance, savings and enhance Payor profitability. The two companies developed concepts in compliance with CMS coverage / billing requirements including National and Local Coverage guidelines, Medicaid, and across the entire spectrum of claim types which are customizable to Payor specific policies. The Platform is designed for truly insourcing PI process for Payors, so that it can manage PI ideation, concepts execution to recovery, collaboration via audit workflow and visibility through real-time reports. The engine incorporates edits and complex algorithms that support Clinical and Coding Review. The engine can be deployed as a cloud-based SaaS solution or based on customer needs it can also be deployed within the customer’s cloud or on-premises IT infrastructure.

Discussing the partnership, Peggy Barber, Founder & CEO of Paytegrity and Rajasekhar (Raj) Maddireddy, Co-founder of CoverSelf, mentioned that the experience and expertise of Paytegrity in ideation, detection and end to end Clinical & Coding Review management coupled with CoverSelf’s powerful next generation PI platform with capabilities encompassing AI and ML, the founders believe their collective vision of supporting Payors with a robust library of rules and concepts that Health Plans can readily access and manage, supported by business intelligence and reporting tools, will enable both partners to focus on their core strengths and complement each other through this partnership to create synergies and provide the Health Plans with an end to end full service PI offering from ideation to validation and recovery.

Paytegrity is based out of Jacksonville, FL and founded by industry veterans with over decades of experience setting up and managing PI programs and Selections and Client Engagement functions that helped identify and recover millions of dollars in overpayments for leading Health Plans. Paytegrity’s vision is to be the selection rules and concepts ideation partner for Health Plans to advance Prepayment PI solutions.

CoverSelf is based out of San Francisco, CA with R&D offices in Bengaluru, India. CoverSelf founding team has decades of combined unique experience in healthcare claims & PI and technology. CoverSelf’s mission is to empower every stakeholder in the healthcare claims ecosystem with a truly cutting-edge cloud-native, holistic & customizable platform that prevents and adapts to ever-evolving claims & payment inaccuracies.

Contact
Paytegrity
Peggy Barber, Founder & CEO
Email – info@pay-tegrity.com
www.pay-tegrity.com

CoverSelf
Rajasekhar (Raj) Maddireddy, Co-founder
Email – hello@coverself.com
www.coverself.com

Peggy Barber and Raj Maddireddy
Paytegrity and CoverSelf
info@pay-tegrity.com; hello@coverself.com
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