Delivering innovation, value, and results in payment integrity services

CGI ProperPay is a holistic payment integrity solution used to identify and address improperly priced claims. Its cloud-agnostic, modular-based structure can be customized to align with an organization’s strategic objectives while addressing key operational needs. Its flexibility allows for integration with existing internal and external systems, providing scalability. Our solution leverages technologies such as artificial intelligence (AI), machine learning (ML), and natural language processing (NLP) in conjunction with healthcare industry expertise.

Explore how CGI ProperPay is designed to protect, plan, perform, preserve, predict and prevent within the payment integrity ecosystem.

Protect
Plan
  • Understand your environment, challenges, and goals to provide comprehensive needs assessment
  • Execute long-term strategy
Perform
  • Efficiently capture, classify, and intelligently annotate documents
  • Create and test new rules/concepts to streamline processes
  • Optimize operational workflow and insights to support workforce
Preserve
  • Establish effective communication with payers and providers
  • Achieve equilibrium within the claims payment lifecycle
Predict
  • Leverage advanced technology to identify hidden patterns and anomalies
  • Anticipate claims payment inaccuracies
Prevent
  • Apply analytics and industry expert insights
  • Identify and recommend appropriate claim coding
  • Reduce and prevent errors leading to rework

CGI ProperPay solution modules

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Edit Studio - Rules management

A library of cognitive business rules that can be customized to payer-specific reimbursement rules and policies. CGI’s standard suite of edits has been developed and refined through more than 30 years of experience to identify the claims with the highest probability of payment errors. You have the flexibility to subscribe to any or all of our edit packages, build your own customized rules, or choose a combination of both.

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Audit Studio - Workflow management

Our comprehensive workflow solution allows the auditor to focus on phases of the audit process, from the screening of claims to the audit itself. The system provides reference screens for auditing guidance, grouping, and pricing to aid in efficient reviews that are defensible to the highest level of appeal. AI integration allows the auditor to access related itemized bills or medical records within the audit screen.

Woman on phone with customer

Communications Studio - Real-time interaction

Encourages real-time communication between payers and providers for medical records and itemized bill requests and submissions. Facilitates the sharing of audit findings that allow a provider to respond with agreement or appeal, and confirm which claims require pricing adjustments to be sent to the claims system for adjudication. Payers and providers can gain insights into the volume of requests, adjustments, and appeals and the timeliness of responses when accessing the studio.

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AVA - AI decision intelligence

Increase audit team productivity by leveraging CGI ProperPay AVA, an AI decision intelligence engine that captures and organizes medical records and itemized bills into a digitally readable format. ProperPay AVA can classify data into 17 document types, highlighting key data points and allowing the user to identify data through NLP-powered search.

Learn more about ProperPay AVA

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Claims Intelligence - Advanced data analytics

Advanced analytical techniques detect trends and patterns to identify improper payment scenarios, support concept development, select cases for review, and optimize staffing models. CGI ProperPay combines claims data with other data sources, such as audit results, to refine targets.

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Doc Indexer - Data management

Based on defined business requirements, all applicable claims data is imported into the database, which is continually updated. This enables a comprehensive view of the overall history and provides a basis for trend analysis and predictive modeling. Other data sources, such as provider and member data, are incorporated into the system to enhance analytical capabilities.

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Learn how to leverage technologies such as AI, ML, and NLP to predict, prevent, and recover improper payments.