Pareto combines advanced analytics with the complex regulatory requirements of CMS to identify and prioritize potential Commercial, Individual, and ACA claim overpayments made by health plans due to incorrect or missing Medicare primacy information.
With Pareto, clients achieve an average of 6:1 ROI, with $5 to $7+ PMPY average recoveries across commercial, ACA, and Medicaid populations.
Optimize Recoveries and Reduce Your Compliance Risk Today
Section 111 Reporting
Improve Pre-Payment Accuracy
We modernize the collection and management of information reporting to CMS to ensure compliance with regulatory requirements. With our solution, we reduce the number of errors received on submissions and minimize dependencies on error resolution and coordination with CMS.
Ensure claims payment accuracyCoordination of Benefits
Identify And Recover Incorrect Claim Payments
With Payment Integrity, health plans can recoup lost dollars and minimize compliance exposure from mistaken claims payments. Our data solutions help create a comprehensive view into improving your overall payment process.
Remediate inaccurate paid claimsCapabilities
Pre-payment Evaluation
Mandatory Insurer Reporting
MSP Data Collection
Mitigate Compliance Risk
Post-payment Evaluation
Coordination of Benefits
Streamline Reporting
Remediation of Paid Claims
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.
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