payers

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.

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payment accuracy

Verscend Payment Accuracy solutions offer payers a continuum of payment accuracy and cost containment services. A convergence of data, technology, and analytics, our suite of solutions leverages another important element—human expertise. From real-time claims editing to fraud detection and prevention, we employ a unique process that drives results.

claim accuracy

Claim Accuracy combines 17 million open sourced edits and a next-generation technology platform with expert human review to stop outlier claims prior to payment. The combination of these two offerings gives payers a solution that addresses the errors, mistakes, and waste normally found by editing solutions, but also abusive behavior related to modifier and office visit utilization.

fraud detection

Our fraud monitoring solution bundles provider profiling, predictive modeling, case tracking, and Special Investigations Unit (SIU) services for total protection from medical fraud, waste, and abuse. Verscend identifies various billing behaviors, coding rule violations, aberrant billing patterns, and known schemes, as well as unknown patterns.

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quality improvement

The ability to collect and analyze accurate, timely information about the care that individuals receive has never been more important. Plans—and increasingly providers—are looking for a true strategic partner to help measure and report evolving quality metrics confidently, efficiently, proactively, and repeatedly. Verscend leads the way with our top-rated solutions.

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
retrieval

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.

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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.

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performance analytics

For 20 years, Verscend Performance Analytics solutions—including the ground-breaking DxCG Intelligence risk adjustment and predictive models—have been helping payers understand and do what's best for their members, minimizing clinical and financial risk in the process.

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PRODUCT INFORMATION

Payment Accuracy

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WHITE PAPER

Turning Fraud, Waste, and Abuse Leads into Turnkey Allegations

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BROCHURE

Corporate Overview

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