NHCAA Partner Directory
NHCAA’s Platinum, Premier and Standard Supporting Members are leading providers of products & services to the health care anti-fraud industry, are valued partners who support our mission, and have demonstrated outstanding commitment to the fight against health care fraud.
Download the Anti-Fraud Solutions Guide for more information on NHCAA Supporting Members.
PLATINUM SUPPORTING MEMBERS
4L Data Intelligence
2333 San Ramon Valley Blvd.
San Ramon, CA 94583
Phone: 925.217.4550
Email: info@4LData.com
Website: 4ldata.com/
4L Data Intelligence™ is the Integr8 AI™ powered company focused on helping our customers and partners deliver better healthcare, insurance and government services at a lower cost by improving data, provider, payment and decision integrity. We are committed to USING THE POWER OF INTEGR8 AI™ TECHNOLOGY FOR GOOD by helping healthcare payers, health systems, governments and insurers deliver better services and care and reduce trillions of dollars in out-of-control costs by making actionable data accessible in real-time, automating inefficient processes and preventing fraudulent, wasteful and abusive payments that drive up costs. For more information visit 4LData.com.
Alivia Analytics
400 TradeCenter, Suite 5900
Woburn, MA 01801
Phone: 617-227-5111
Email: info@aliviaanalytics.com
Website: www.aliviaanalytics.com
Alivia Analytics is the industry leader providing solutions that are revolutionizing healthcare payment integrity. Boasting the lowest false positive rates in the industry, Alivia Analytics delivers unprecedented speed, accuracy and usability. Integrated case management, user-friendly dashboards, simple data ingestion and flexible workflows put new power in the customers’ hands. By designing technology that adapts to existing business processes, healthcare payers can rapidly generate more confident outcomes and realize greater ROI. Let’s achieve healthcare payment integrity, finally.
Codoxo
2405 Commerce Ave NW, Suite 500
Duluth, GA 30096
Phone: 470-223-3592
Website: http://www.codoxo.com
Email: info@codoxo.com
Cotiviti
10701 S River Front Pkwy
Unit 200
South Jordan, UT 84095
Phone: (770) 379-2800
Email: answers@cotiviti.com
Website: cotiviti.com/solutions
Payment integrity leadership requires experience, scalability, innovation, and proven value. Cotiviti has spent 20+ years honing our solutions specifically to drive exceptional value for our clients all along the claim payment life cycle — from prospective payment policy management and clinical coding review to both pre and postpay chart review and fraud investigation. We help clients work more effectively across their payment accuracy silos by deploying the right approach at the right time, driven by a full-service model and the deepest industry expertise.
Deloitte
1633 Broadway
New York, NY 10019-6708
Phone: 703.509.5824
Email: gacantrell@deloitte.com
Website: http://www.deloitte.com
Deloitte’s Program Integrity (PI) practice is dedicated to helping agencies transform how we combat Fraud, Waste, and Abuse (FWA) and prevent improper payments. Our PI practice includes career federal and state healthcare PI professionals, data scientists, and clinicians who support you through our end-to-end PI platform, Pallium™, to identify risks and vulnerabilities associated with providers, and beneficiaries. Deloitte brings a suite of analytics to analyze claims/encounters and third-party data to better identify risky providers and transactions. We also support critical client needs by conducting fraud risk assessments, leading strategic planning initiatives, assist process improvement, and provide pre- and post-pay audit and investigation support.
EXL Health
320 Park Avenue
29th Floor
New York, NY 10022
Phone: 212.277.7100
Website: https://www.exlservice.com/health
Email: lookdeeper@exlservice.com
EXL Health combines deep domain expertise with analytic insights and technology-enabled services to transform how care is delivered, managed, and paid. Applying our expertise in AI, analytics and cloud, we make sense of your health-related data, enabling you to improve outcomes, optimize revenue, and maximize profitability across the care continuum. Our digital dexterity and Human Ingenuity are the catalysts to solve complex healthcare problems. With data on more than 260 million lives, we work with hundreds of organizations across the healthcare ecosystem. EXL’s proprietary Payment Services analytics platform and digital first analytics support our clients in maximizing reimbursement and ensuring payment integrity. To learn more visit https://www.exlservice.com/health.
GDIT
3150 Fairview Park Dr.
Falls Church, VA 22042
Phone: 1-800-242-0230
Website: www.gdit.com
Email: info@gdit.com
GDIT is a global technology and professional services company that delivers consulting, technology and mission services to every major agency across the U.S. government, defense and intelligence community. Our 30,000 experts and consultants extract the power of technology to create immediate value and deliver solutions at the edge of innovation. We operate across 30 countries worldwide, offering leading capabilities in digital modernization, AI/ML, cloud, cyber and application development. Together with our clients, we strive to create a safer, smarter world by harnessing the power of deep expertise and advanced technology.
Health at scale
10 Almaden Blvd
Suite 960
San Jose, CA 95113
Website: www.healthatscale.com/
Email: info@healthatscale.com
Health at Scale is advancing the next-generation of fraud, waste and abuse detection through real-time context-aware intelligence that allows health plans and third-party administrators to detect and act on inappropriate payments in pre-adjudication. Founded by artificial intelligence and clinical faculty from MIT, Harvard, Stanford and U-Michigan, the company offers software solutions and fully-managed technology-enabled services to contain medical costs and reduce administrative burden. Health at Scale’s customers include some of the largest payers and TPAs in the U.S.; with the company’s breakthrough Precision FWA Detection™ technology consistently demonstrating 1-2% reduction in total medical spend in large prospective deployments for Medicare Advantage and Commercially-Insured populations.
Healthcare Fraud Shield
16052 Swingley Ridge RoadSuite 200
Chesterfield, MO 63017
Phone: 888.333.8140
Website: www.hcfraudshield.com
Email: info@hcfraudshield.com
Healthcare Fraud Shield was founded in 2011 to offer innovative fraud, waste, and abuse (FWA) solutions to the healthcare insurance industry. The focus of Healthcare Fraud Shield is solely on healthcare fraud prevention and payment integrity with a successful approach based on many unique advantages we deliver to our clients.
Healthcare Fraud Shield’s fraud, waste, and abuse software as a service platform – FWAShield™ – is an integrated solution consisting of PreShield™ (pre-payment), AIShield™ (AI), PostShield™ (post-payment), RxShield™ (pharmacy analytics), QueryShield (ad hoc query and reporting tool) and CaseShield™ (case management).
FWAShield™ was developed by industry leading healthcare subject matter experts with the latest technology available today to provide the most affordable, flexible, transparent, efficient, and effective solution in the marketplace.
MedReview Inc.
199 Water Street, 27th Floor, New York, NY 10038
Phone: 734-262-0242
Website: https://www.medreview.us/
“Physician Approved Payment Integrity” makes MedReview a different type of payment integrity firm. Our doctors review, approve and document every claim we reassign providing our clients with the lowest appeal overturn rate in the industry. This focus on clinical quality returns the highest savings per review.
MedReview delivers Pre-Payment and Post-Payment DRG, Hospital Bill Audit, and Readmission reviews and audits. As a part of the solution, our proprietary selection algorithm delivers a targeted selection resulting in a 40% or greater reassignment rate. MedReview is proud to work with three (3) of the top five (5) largest health plans in the US.
MultiPlan
115 Fifth Avenue
New York, NY 10003
Phone: 866.750.7427
Email: sales@multiplan.com
Website: https://www.multiplan.us/
MultiPlan offers a total healthcare cost containment solution that includes payment and revenue integrity, network-based and analytics-based services, helping payers reduce the cost of care and improve competitiveness. Unlike similar products, MultiPlan’s payment integrity services include a personal review by an experienced clinician in addition to automated reviews. This human touch allows us to catch more complex issues indicative of waste and abuse, that go undetected by other products. For over 40 years, we’ve processed claims prepayment. Today more than 1 million providers participate in our networks, partnering with us to control claim costs. Our rich history helps us resolve payment integrity issues quickly while minimizing provider abrasion – all before our clients pay a dime.
Optum
11000 Optum Circle
Eden Prairie, MN 55344
Phone: 800.765.6807
Website: www.optum.com
Email: empower@optum.com
At Optum, we are a leading health services innovation company dedicated to helping make the health system work better for everyone. We create simple, effective and comprehensive solutions for organizations and consumers across the whole health system by integrating our foundational competencies of consumer experience, clinical expertise, data and analytics, and embedded technology into all Optum services. By understanding the needs of our customers, members and patients and putting them at the center of everything we do, we will achieve our aspiration of improving experiences and outcomes for everyone we serve while reducing the total cost of care.
SAS
100 SAS Campus Dr
Cary, NC 27513
Phone: 919.677.8000
Email: carl.hammersburg@sas.com
Website: www.sas.com/fwa
SAS is the leader in advanced analytics software and services, and the largest independent vendor in the business intelligence market. With SAS® payment integrity solutions, health care organizations can detect suspicious activity, prevent improper payments, and uncover collusion and multiparty fraud schemes. Since 1976, SAS has given customers around the world THE POWER TO KNOW®.
Shift Technology
321 Summer Street, 7th Floor
Boston, MA 02210
Phone: 817-456-9229
Website: www.shift-technology.com
Email: contact@shift-technology.com
Shift Technology delivers AI decisioning solutions to benefit the global insurance industry and its customers. Our products enable insurers to automate and optimize decisions from underwriting to claims, resulting in superior customer experiences, increased operational efficiency, and reduced costs. The future of insurance starts with Decisions Made Better. Learn more at www.shift-technology.com.
PREMIER SUPPORTING MEMBERS
STANDARD SUPPORTING MEMBERS
Avalon
3405 W. Dr. Martin Luther King Jr. Blvd., Suite 200
Tampa, FL 33607
Phone: (817) 348-0000
Website: www.avalonhcs.com
Email: avalon-info@avalonhcs.com
CERIS
5128 Apache Plume Rd, Suite 400
Fort Worth, TX. 76109
Phone: (817) 348-0000
Website: www.ceris.com
Email: marketing@ceris.com
ClarisHealth is the answer to the health plan industry’s siloed solutions and traditional models for identification and overpayment recovery services. We provide health plans and payers with total visibility into cost containment operations through our one-of-a-kind advanced technology platform Pareo®. The Pareo Fraud solution is an A.I.-powered web-based platform for investigators, SIU leaders and other areas of a healthcare payer’s Payment Integrity operation to detect, create, manage, process and report on leads and cases that are potential fraud, waste, abuse and general overpayments. The solution easily integrates with ClarisHealth’s Total Payment Integrity solution suite. As a standalone offering, Pareo Fraud helps SIUs and its investigators become more efficient in their day-to-day activities, better monitor the success and ROI of the unit, and improve the decisioning time for improved recoveries.
Context 4 Healthcare, Inc.
55 Shuman Blvd., Ste 650
Naperville, IL 60563
Phone: 800-783-3378
Website: www.context4healthcare.com
Context 4 Healthcare is the leading provider of cloud-based healthcare compliance solutions in verifying medical claim accuracy for health plans and benefits administrators. These solutions are designed to review for complex coding accuracy, identification of potential fraud, waste, and abuse (FWA) situations before the claim is paid, and to review for potential FWA situations in claim history. Context’s Medical Director and our team of certified claim experts maintain solution rules weekly for up-to-date compliance and identification of potential new FWA schemes. The semi-annual creation of our proprietary UCR fee schedules is also a source for identifying potential FWA situations leading to new solution rules, a capability unique to Context. Our experts also blog for your benefit, letting you know about emerging situations that may affect your compliance, and what Context is doing about it. Since 1988, Context has been the healthcare industry’s leading compliance specialist.
IBM
1 Orchard Road
Armonk, NY 10504
Phone: 1-646-565-9684
Website: https://www.ibm.com/consulting/government
ICF is a global advisory and technology services provider, but we’re not your typical consultants. We combine unmatched expertise with cutting-edge technology to help clients solve their most complex challenges, navigate change, and shape the future.
Federal healthcare. Our clinical quality measures support leads to more effective and efficient, patient-centered, safe, timely, and equitable care for beneficiaries and greater transparency for providers and the public.
- Program integrity and fraud detection
- BPO and case management
- Health care quality
- Contact center and healthcare technical assistance
- Benefit eligibility and administration
Data Analytics: We anchor our data solutions in deep domain expertise. We have 2,000+ public health experts who understand your systems, policies, and regulatory frameworks. We pair them with data science and technology experts to accelerate meaningful solutions tailored to mission needs.
Artificial Intelligence: For over 20 years, we’ve used AI to unlock insights and drive transformation for our clients. From machine learning and computer vision to chatbots and generative AI, our experts draw from the full spectrum of AI tools to meet the most complex challenges head on. We help customers apply the power of large language models and generative AI to boost workforce efficiency, optimize service delivery, and accelerate mission innovation.
MITRE
202 Burlington Rd
Bedford, MA 01730-1407
Phone: 781.271.2000
Website: http://mitre.org/
MITRE is a not-for-profit organization that operates research and development centers sponsored by the federal government.
We operate FFRDCs-federally funded research and development centers-which are unique organizations that assist the United States government with:
- Scientific research and analysis
- Development and acquisition
- Systems engineering and integration
We also have an independent research program that explores new and expanded uses of technologies to solve our sponsors’ problems.
MITRE’s Sole Focus Is to Operate FFRDCs
MITRE is chartered to work in the public interest. We have no commercial interests. We have no owners or shareholders, and we can’t compete for anything except the right to operate FFRDCs. This lack of commercial conflicts of interest forms the basis for our objectivity. We also have the ability to acquire sensitive and proprietary information from the government and industry to inform our work. These organizations are able and willing to share data because they know we won’t use it for a competitive advantage.
Moreover, because we operate multiple FFRDCs, we foster a culture of knowledge sharing. We apply what we learn from addressing one sponsor’s challenges to similar issues faced by other federal agencies. This means when sponsors engage with us, they have access to all the minds of MITRE.
