ClarisHealth Inc. - Payment Integrity Tech for Health Plans

ClarisHealth Inc. - Payment Integrity Tech for Health Plans ClarisHealth is creating a better way for payment integrity through integrated technology. The past has prepared us for our present and future. It’s a win-win.

Our founders and members of the leadership team were instrumental in the development of the cost-containment industry 20+ years ago. There were two goals we had for our clients back then: lower the cost of recovery and revolutionize the cost containment industry. New solutions were created, and in a short period of time we were returning over $1 billion per year to our clients. ClarisHealth has ri

sen to challenge the industry’s traditional models for identification and recovery services, and after our first two years of business we now service clients representing over 110 million lives. The passionate leaders of ClarisHealth bring over 100 years of combined experience to our clients. Experiences that have led us to make radical changes and upgrades in the operational and technological systems that have permeated the payer network for years. We’re leading the revolution in healthcare, and this is only the beginning. What sets us apart? TOTAL PAYMENT INTEGRITY™ BRINGS IT ALL TOGETHER

Technology: It’s all too easy to get bogged down managing the day-to-day of internal versus third-party resources. Our innovative technology PAREO™ allows us to provide health plans with a flexible model that offers an outsource-to-insource approach for one point of accountability. Services: Not just another vendor to supplement your cost containment, audit and recovery, or fraud waste and abuse operations. ClarisHealth integrates pre-pay cost avoidance and post-payment recovery so you can follow the transaction through the whole cycle and find the right balance. Expertise: Build long-lasting relationships that understand your unique objectives in the marketplace. We align our strategies and solutions to ensure you achieve your goals: from choosing the right vendors, to implementing the right solutions, to building out your entire payment integrity operations.

06/04/2025

It's your turn to be in on the secret leaders from all over the country already know...

If you want to grow your program, share your story, and build your ...

The Conference returns to Nashville April 14-16, 2026!

It's the industry's only event that's...

☄️ All payment integrity
☄️ No sales pressure

And it's FREE to attend for all leaders.

Want to join us?

Registration opens this fall. But you can start making your plans NOW. Add your name to the waitlist for priority access at https://hubs.ly/Q03qz3hb0

09/17/2024

Are you ready for the all-new Power of Payment Integrity Conference?

It's the industry's only peer-led payment integrity conference. No sales pitches. No pressure. Just people like you...

1. Telling their stories of challenges and wins
2. Teaching each other how to grow your programs
3. Creating the future of the industry together

All united around the personal impact you're making on , your community and the industry.

Because you're better together.

Registration is NOW OPEN. Make your plans to join us in Nashville April 21-23.

Don't wait. is absolutely FREE for to attend. But at these prices, tickets will go fast.

Save your seat today at https://hubs.ly/Q02Q36zb0

Spreadsheets are easy to use, which is why 94% of healthcare organizations rely on them. But they aren’t the right tool...
08/01/2022

Spreadsheets are easy to use, which is why 94% of healthcare organizations rely on them.

But they aren’t the right tool for managing the complex data and audit processes required by payment integrity and special investigation units.

Digital processes and workflow automation can unlock thousands of hours for claims managers, auditors, vendor managers, and more. But bridging the gap between manual spreadsheets and digital tools can be a challenge.

Process digitization is a standard part of Pareo deployment, where our team of experts are hands on with clients to overcome the challenges associated with manual processes.

Read more at: https://hubs.ly/Q01hSVVm0

06/30/2022

When it comes to innovation, transparency comes up a lot – inside a health plan as well as with vendors and providers - growing in importance to ensure well-informed, accurate decision-making.

In this episode of Payment Integrity Perspectives, we hear from experts on why having full transparency into payment integrity operations is essential to success and the importance of data-driven decision making.

🎧 Listen to the full episode on your favorite streaming platform or at https://hubs.ly/Q01ckM_M0

Once an organization has determined its biggest needs for technology and narrowed the field of vendors, it’s time to sta...
06/29/2022

Once an organization has determined its biggest needs for technology and narrowed the field of vendors, it’s time to start thinking about how to successfully adopt and scale the new solutions.

Despite significant investments in new technologies over the past decade, many organizations see their operations slow down due to underutilization of technology.

Often, this inefficiency is because new technology hasn’t been adequately introduced, so users continue to use old manual solutions concurrently with new systems.

No matter how “big” or “small” a solution, and no matter how thoroughly vetted, if it’s not adopted by end-users, its benefits will elude the company.

In fact, end-user adoption is arguably more critical to the success of broader digital transformation initiatives than mandates from the top. Below, we share best practices for successful technology adoption.

Explore more details in the full article at https://hubs.ly/Q01ckJFw0

Most health plans find that functionality is the top consideration when evaluating their technology options – and conseq...
06/28/2022

Most health plans find that functionality is the top consideration when evaluating their technology options – and consequently, the tech companies and services providers that develop these solutions.

Nested under functionality are several areas of evaluation that make up a comprehensive payment integrity checklist.

For a full outline of this functionality, explore the checklist we put together at https://hubs.ly/Q01ckNTr0

As much as 80% of relevant clinical information is stored as unstructured free text. This means that manually evaluating...
06/23/2022

As much as 80% of relevant clinical information is stored as unstructured free text. This means that manually evaluating hundreds of pages of medical records and supporting documentation can lead to inefficiencies, human error, and unnecessary friction with providers.

In seeking out a clinical audit solution, look for functionality that digitizes clinical content through advanced artificial intelligence capabilities.

This will make data easily searchable, filterable, and sortable, creating a strong foundation for flagging suspect charges and increasing auditor efficiency.

Explore a better way of conducting medical claims audits in this article written by our experts: https://hubs.ly/Q01ckNxT0

06/22/2022

Technology solutions are often the cornerstone of a health plan’s innovation journey, rising to meet increasingly intricate challenges with speed and accuracy. But as you build your technology stack, ask this: Is it simplifying existing burdens? Or adding even more complexity to your organization and processes?

When seeking a technology solution, ensure that it can accommodate the needs of your health plan, while also considering scalability and quality. Furthermore, evaluate the flexibility of the solution as it relates to the unique approaches and processes of your organization.

A combination of these things will ensure the solution leads to a continued return on investment for the long term.

🎧 Listen to the full podcast episode on your preferred streaming platform or at https://hubs.ly/Q01ckJLz0

In-house development projects include the option of being self-hosted via an on-premise server. On the other hand, most ...
06/21/2022

In-house development projects include the option of being self-hosted via an on-premise server. On the other hand, most modern technology solutions that a health plan would buy are offered in a Software as a Service (SaaS) model.

Cloud solutions are more secure than ever and offer intrinsic benefits for health plans. In fact, SaaS has revolutionized the way technology in business is used.

But some health plans remain hesitant to rely on SaaS, often because of misconceptions regarding the technology.

ClarisHealth Chief Technology Officer, Jim Weathersby, explains that “Health plans have historically been hesitant to move to the cloud due to fears about giving up control of their data and putting sensitive information at risk. However, that hesitancy is now being replaced by the realization of its ultimate inevitability. This mindset shift is largely due to data overload.”

For more on how SaaS could benefit your payment integrity function, check out this article: https://hubs.ly/Q01ckJLw0

With the awareness that stakeholders and processes across health plans are increasingly interconnected, and that the pac...
06/16/2022

With the awareness that stakeholders and processes across health plans are increasingly interconnected, and that the pace of change is accelerating, adopting technology with flexibility and data visibility in mind is a smart move.

Most of our clients find their path lies between a hybrid model of outsource-to-insource or pursuing both concurrently in an optimized combination of the two.

Health plans can strategically outsource and insource select payment integrity efforts based on current resources while planning to adjust that mix over time to attain crucial internalization goals.

While you’re ramping up internal auditor efforts and expertise, strategically stacking vendors lets you accelerate your audit goals at scale.

Explore more about the outsource to insource strategy in this article https://hubs.ly/Q01ckKqm0

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Franklin, TN

Opening Hours

Monday 9am - 5pm
Tuesday 9am - 5pm
Wednesday 9am - 5pm
Thursday 9am - 5pm
Friday 9am - 5pm

Telephone

(844) 889-6706

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