Capture Accurate Monthly Capitation Payments and Maintain Compliance

Our Premium Integrity solution helps plans navigate Medicare Secondary Payer (MSP) and End Stage Renal Disease (ESRD) reporting complexities, enabling them to recoup underpaid capitation payments and mitigate compliance risk.

To date, we have uncovered over $100 million in recoveries for Premium Integrity clients.

Medicare Secondary Payer (MSP) and End Stage Renal Disease (ESRD) Reporting

We uncover and correct inaccuracies reported to CMS for MSP validation. Additionally, we help reconcile inconsistencies in data between the MMR and claims data to properly classify ESRD status and recover appropriate payments for those members.

Significant Opportunity for Health Plans

  • Capture six-year lookback: health plans can reconcile most premium mispayments for the current year and up to six years prior.
  • Increase revenue: properly classified member statuses can lead to significant capitation payment adjustments.
  • Mitigate compliance risk: correctly documenting Medicare Secondary Payer versus Primary assures plans remain compliant with CMS.
  • Ongoing revenue accuracy: monthly monitoring ensures complete and accurate premium revenues year-round, as well as sustained compliance with CMS guidelines.

Why Pareto?



We look both ways to recover underpayments and identify overpayments to mitigate compliance concerns.



We provide a third-party evaluation of internal and/or vendor-led performance.



Our processes are centered around ensuring members receive the benefits they are entitled to, which delivers value to members and health plans.

A Powerful Foundation


Our Data Management Platform

Pareto’s Data Management Platform, the foundation to our solutions, is built around data lake, artificial intelligence, and open source big data technologies to allow us to effectively ingest data in all formats and types at scale, organize them with appropriate data governance mechanisms within our data catalog, and provide efficient configuration capabilities to democratize data access and analytics.


See it and Believe it

Our demos say it all. Tell us about your challenges and we’ll show you how we can help you overcome them.

Schedule a Demo