Healthcare professional auditing information at desk

Preventing payment errors while ensuring compliance and accuracy

Private and public health payers lose over a trillion dollars yearly in wasteful spending caused by clinical waste, inaccurate payments, and erroneous claims, among other issues. As populations increase and regulations change around healthcare payment integrity, health payers must increase their capacity to support growth in improper payments while building the infrastructure to implement preventive controls and analytics techniques to detect trends and patterns that identify improper payment scenarios.

Health organizations can address the processes leading to wasted spending through error prevention, payment recovery and reimbursement solutions. By working with partners and utilizing advanced solutions, health organizations can boost efficiency, improve processes and proactively identify improper payments before they happen.

CGI's payment integrity performance by the numbers

Savings found in
60%
of claims audited
Recovered more than
$3 billion
in improperly paid claims
We set the standard with an industry leading
96%
appeal uphold rate

How CGI delivers payment integrity services

With over 30 years of experience in Medicare, Medicaid and commercial plans, CGI knows what clients value and helps your organization take a holistic approach to preventing payment errors while ensuring the highest levels of compliance and accuracy. Our team takes a personalized approach to address fraud, waste and abuse, considering the challenges and needs of each organization. Whether your organization is seeing an increase in error rates or attempting to meet FWA targets, we leverage our experience and effective audit concepts to solve payment integrity challenges and support your teams in getting funds to those most need it.

With over 10,000 facilities supported by CGI solutions and services, we focus on reducing healthcare wasteful spending, offering scalable, innovative solutions to enhance the payer experience.

home health worker with female patient

Learn more about our innovative payment integrity solutions

CGI ProperPay

If you need a proven way to predict, identify, manage and recover improper payments, driven by advanced analytics, discover discover CGI ProperPay. Since 1990, our solution has helped payers/insurers improve payment integrity and recover well over $3 billion in improper payments.

 

Recovery audit solutions

As a leader of innovative solutions in the healthcare payer/insurer industry, we help clients reduce and recover lost revenue. Our comprehensive healthcare payment integrity solution maximizes recoveries while developing new policies to reduce error rates and unnecessary spending.

Reimbursement solutions

Well-developed reimbursement methods control medical costs, improve payment predictability and provide a method to compare the cost effectiveness of providers. From small to large payers, put our expertise to work for you.

Ready to learn more about our payment integrity services?

Connect with out team to learn how we support the payer industry, delivering the best complex-audit-review overturn rates in the market through our suite of innovative solutions and services.

Client partnership experience

With more than 30 years of experience in government and commercial health plans, we know what clients value. Let us help your organization address fraud, waste and abuse.

Over our long-term relationship, CGI has been an incredibly reliable vendor that continuously drives outstanding results while consistently looking for areas of improvement. Our success with combating billing and coding errors and abuse continues to be accelerated by our partnership with CGI.

Kurt Spear, Vice President, Financial Investigation & Provider Review, Highmark Health

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