make smart decisions based
on sound data

We are moving to a system that rewards the right care for the right patient at the right time at the right cost in the right venue. But getting there is hard work. Payers are in a unique position to influence the changes going on in healthcare, but they need to make smart decisions based on sound data. Whether you are looking to improve payment accuracy, risk adjustment, care quality, or performance analytics, Verscend has the most complete set of solutions to meet your needs, backed by decades of experience and our passionate commitment to your success.


Payment Accuracy

an end-to-end approach for maximum cost containment

Verscend Payment Accuracy is the industry’s only real-time, pre-pay, integrated claim accuracy and fraud detection solution scalable for any size of payer. A convergence of technology, data, and analytics, our solutions incorporate a unique element: expert clinical review, a process that drives increased accuracy of claims payment.

Claim Accuracy

Verscend Claim Accuracy offers a complete payment approach that optimizes your claim processing and increases cost containment on improper professional and outpatient facility claims. We combine SaaS editing technology and clinical claim review services to ensure the accuracy of claim payments, increase adjudication speed, and reduce health plan technical and clinical resource needs—all while causing no disruption to your current workflow and no delay in payment to your providers.

Fraud Detection

Verscend Fraud Detection combines advanced analytics and clinical investigative review to deliver actionable case referrals to health plan cost containment staff and special investigations units (SIUs). The result is pre- and post-pay protection from aberrant billing and known and emerging fraud schemes.

Inpatient Accuracy

Verscend Inpatient Accuracy performs a combination of claim editing, clinical validation, and complex claim review of high-dollar fee-for-service hospital bills. Although these claims may only compose 1 to 2 percent of typical inpatient claims, they often represent 5 to 12 percent of inpatient costs.

Dental Accuracy

Verscend Dental Accuracy is a full-service offering of dental claim editing, clinical validation services, consulting, and fraud detection.


Risk Adjustment

Our Risk Adjustment solutions offer end-to-end support for all payment and reconciliation facets of a risk-adjusted payment model. Our solutions are built around the CMS calendar and leverage the experience of our professional staff.

Medicare Risk Adjustment

We believe that the foundation for building a successful and integrated risk-adjustment program is a solid understanding of data. We help clients ensure appropriate revenue, improve quality performance, increase payment accuracy, and engage members with the support of a fully compliant program.

Commercial Risk Adjustment

Verscend Commercial Risk Adjustment solution calls upon decades of experience in Medicare Advantage risk adjustment to equip Qualified Health Plans with an integrated set of tools to succeed in this revenue-critical risk adjustment environment. From suspect targeting and record retrieval to detailed coding, risk score calculation, and Edge Server hosting, our data and analytics offer an accurate view of your plan’s population.


Quality and Performance

Verscend’s Quality and Performance solutions allow health plans to not only analyze and report quality measures accurately and efficiently but also help all healthcare stakeholders drive the purchase, delivery and utilization of higher-value healthcare.

Quality Measurement
and Reporting

It's no longer enough to simply measure, report, and improve HEDIS compliance once a year. Our software drives a level of efficiency that enables year-round measurement of HEDIS, Stars, P4P, QHP, state, and custom measures—allowing health plans to continuously refine their quality improvement programs and achieve better results.

Medical Record

Verscend HEDIS Medical Record Retrieval services stand out for the caliber of our software and the expertise of the people who use it, ensuring that your budget dollars are spent wisely.

Medical Record Abstraction

Verscend HEDIS Medical Record Abstraction services deliver rapid, accurate abstraction of clinical data components that document the provision of compliant care. This information is critical to optimizing health plan quality scores and has a direct impact on revenue.

Medical Intelligence

Fueled by industry-leading DxCG predictive science and evidence-based clinical intelligence, our web-based applications identify and stratify opportunities for clinically sound, financially effective interventions.

DxCG Intelligence

For 20 years, the ground-breaking DxCG Intelligence risk adjustment and predictive models have been helping risk-bearing entities identify and plan for population and individual-level risk.

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Payment Accuracy


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