Is your payment integrity program one program or five vendors reporting five different numbers?
Fragmented vendors and point solutions can’t tell you if the program is actually working. Overlap goes undetected, savings go unproven, and leadership gets a different number from every source.
Our Payment Integrity solution runs prepay, postpay, and complex claim review on one governed foundation, so the program finally adds up.
The forces shaping payment integrity
Coding & Billing Automation Spend
Providers are automating faster than payers are catching up.
Increase in Coding Intensity
More intensive coding, more downstream review burden.
Annual Improper Payments
Across U.S. healthcare programs, and rising.
The Problem: Payment integrity was not designed to operate across disconnected systems
Multiple vendors, internal teams, and point solutions produce and measure data differently. That makes it difficult to see the full program, compare performance, or act earlier in the claim lifecycle. Any AI layered on top inherits the same fragmented view.
The Solution: Start with the challenge you have. Scale from there.
Start with Core Data Foundation, Claims Editing, or Complex Claims Audit, whichever matches your most urgent problem. Each one runs on the same governed foundation, so the next one you add isn’t starting from scratch, and your reviewers and your AI tools are always working from the same trusted data.
Core Data Foundation
Stop rebuilding the same claims, clinical, and provider data for every new initiative. Unify it once into a governed, AI-ready layer, and every payment integrity use case, and whatever comes after it, reads from the same source.
Claims Editing
Stop finding problems after the claim is already paid. Start fixing them before it goes out the door, with transparent, configurable logic you control, not a vendor black box you have to take on faith.
Complex Claims Audit
Stop spending your best reviewers’ time on every claim equally. AI-enabled prioritization surfaces the cases worth a second look and assembles the context automatically, so your team makes the call, not a black box.
Abacus Insights Platform
The shared platform for governed payer data, interoperability, security, and AI enablement.