Drive Payment Accuracy and Prevent Fraud
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Elevate your payment integrity program with real-time provider eligibility data for all licensed providers across every U.S. state and jurisdiction. With our robust data and API, we empower health plans and payers to maintain compliance, improve financial outcomes, and enhance the efficiency of their payment processes.
Find 40% more actionable insights about a provider.
Our solutions analyze claims data, provider histories, and risk indicators to identify patterns that suggest potential fraud, waste, and abuse (FWA), allowing payers to take corrective action before payments are made.
Elevate Payment Integrity with Accurate Provider Data
A core component of effective payment integrity is reliable provider data. Verisys leverages over three decades of expertise in provider data management to deliver accurate, up-to-date information that ensures claims are processed correctly. Our data solutions help:
Identify & Validate Provider Credentials
Licensing Verification
Exclusions & Sanctions
Preventing ineligible providers from receiving payments.
Proactively verify provider eligibility at every stage of the claims process
By incorporating this critical layer of data into payment workflows, healthcare organizations can minimize payment errors, reduce the risk of overpayments, and ensure compliance with regulatory requirements.
Real-World Payment Integrity Impact
In a recent evaluation, a health plan compared 30 days of claims data against Verisys compliance data and identified approximately $2 million in claims that may have been avoided if provider eligibility screening had been incorporated into the claims process.
By combining licensure, exclusions, sanctions, DEA registration, Medicare enrollment, and other provider eligibility data, Verisys helps organizations identify reimbursement risks before payments are made.
Real-time sanctions, licensure, DEA registration, Medicare
Opt-out, and PECOS data delivered in real-time, fully integrated into your claims adjudication process
With Verisys, health plans can implement comprehensive payment integrity programs that leverage predictive analytics to flag high-risk claims and suspicious billing practices. This enables health plans to enhance their payment integrity efforts while ensuring legitimate providers are compensated accurately and promptly.
Reduce Claims Rejections with Effective Eligibility Verification Solutions
Verisys payment integrity solutions offer both point-in-time decisional data, as well as ongoing provider file management and monitoring, ensuring a complete data solution for your compliance program.
Reduce Hiring Risk
By prescreening healthcare providers with Verisys’ comprehensive datasets, organizations can avoid hiring individuals with a history of sanctions, exclusions, or disciplinary actions, minimizing the risk of non-compliance and safeguarding patient safety.
Ongoing Compliance Monitoring
Verisys’ monitoring services provide continuous oversight of provider credentials, licenses, and potential sanctions. This ensures that healthcare organizations remain compliant with evolving regulations and avoid costly penalties.
Enhanced Credentialing Efficiency
By automating license verifications and leveraging advanced matching logic, healthcare organizations can streamline their credentialing process, reduce manual effort, and improve operational efficiency.
Protect Patient Safety and Brand Reputation
Screening against the National Abuse Registry and DEA databases helps organizations ensure that non-licensed personnel and providers do not pose a risk to patients. For example, it can identify individuals with a history of patient abuse, controlled substance violations, or other criminal activities, thereby preventing potential harm to patients and maintaining a safe care environment. This not only enhances patient safety but also protects the organization’s reputation from potential harm.
Mitigate Regulatory Risk
Verisys’ datasets, including FACIS, CDS Monitoring, and OFAC+, help healthcare organizations meet federal and state compliance requirements, mitigating the risk of fines, penalties, and reputational damage.
Verisys Payment Integrity solutions help healthcare organizations ensure payment accuracy, reduce waste, and prevent fraudulent claims.
Compliance That Fits Your Workflow
Our Payment Integrity Solutions are designed for seamless integration into existing claims and payment systems. This allows healthcare organizations to incorporate Verisys’ provider data and FWA analytics directly into their workflows, reducing administrative burdens and improving efficiency.
Whether it’s verifying provider eligibility, detecting fraudulent claims, or ensuring compliance, Verisys helps healthcare organizations implement a streamlined approach to payment integrity that prevents waste, reduces costs, and protects financial assets.
Ensure compliance with federal and state regulations, and maintaining accurate provider credentials.
Our NCQA and URAC accreditations validate that our processes exceed market standards for managing and verifying provider data. By leveraging Verisys’ data, you ensure your organization remains compliant with federal and state regulations, minimizes risk to patients, and protects your brand from reputational damage.
Discover How Verisys Can Enhance Your Payment Integrity Efforts
Ready to enhance your payment integrity programs and prevent waste and fraud? Contact us today to learn how Verisys Payment Integrity Solutions can transform your payment processes and improve financial outcomes.
Frequently Asked Questions: Your Payment Integrity Questions, Answered
Still have questions? We’ve got you covered. Check out the answers to our most commonly asked questions regarding our payment integrity solutions below.
Other Questions?
Reach out to our team to learn more about our offerings.
How does Verisys support healthcare payment integrity?
Verisys helps organizations reduce improper payments by validating provider eligibility before claims are processed and monitoring for compliance changes that could impact reimbursement.
Can Verisys help identify ineligible providers before claims are paid?
Yes. Verisys supports pre-payment screening that helps organizations identify providers who may be excluded, sanctioned, unlicensed, or otherwise ineligible for reimbursement.
Does Verisys integrate with claims processing systems?
Yes. Verisys delivers provider eligibility data through APIs, secure file transfers, and other integration options, making it easy to incorporate compliance checks into existing claims workflows.
What provider data does Verisys use for payment integrity screening?
Verisys uses multiple provider eligibility data sources to support payment integrity, including primary-source licensure data, exclusions, sanctions, DEA registrations, Medicare enrollment status, and other regulatory records. By combining licensure and compliance data with ongoing monitoring, organizations can identify provider eligibility issues before claims are processed and paid.
Why is ongoing provider monitoring important for payment integrity?
Provider eligibility can change after enrollment. Ongoing monitoring helps organizations identify license actions, exclusions, sanctions, and other status changes that could impact reimbursement decisions.
