ClaimShark is the most powerful and flexible enterprise payment integrity management platform available to health plans.

THE BIG PICTURE:

Payers are under increasing pressure to improve payment accuracy and savings while reducing medical costs and abrasion. However, payment integrity often remains siloed and a source of manual process which leads to inefficiencies and avoidable costs.

WHAT IS CLAIMSHARK?

ClaimShark is an enterprise technology solution partner for payers who need to get more out of their Payment Integrity and Audit operations.

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Eliminate Hidden Sources of Savings Leakage In Your Payment Integrity Operations

  • Orchestrate All PI Audits and Vendors
  • Detailed Reporting and KPIs
  • Systematically Reduce Abrasion

Get More out of your own Claims Audit Teams

  • No Point-Solution Fatigue, All Audits One Platform
  • Enhanced Claim Selection and Automation
  • Increased Throughput, Accuracy and Payment Integrity

OUR AI-POWERED SOLUTIONS

AuditShark Platform

Comprehensive Audit
Platform

Boost your PI audit team’s capacity and efficiency with a comprehensive platform designed for all major payment integrity audit types!

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AuditShark COB Platform

A Modern Solution
for COB

Automate COB cost avoidance and overpayment recoveries with AuditShark COB.

cob
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ClaimShark Platform

Enterprise Payment
Integrity Platform

Enhance your payment integrity operations with ClaimShark. Increase savings, reduce appeals, and gain insights with a comprehensive platform!

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CLIENT TESTIMONIALS

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After running the Payment Integrity operations on the ClaimShark platform, we are seeing significant improvements in findings, savings, conversion rate and recovery timelines.

The Data and Technology is helping our internal teams find more overpayments and get higher productivity resulting in greater savings.

– SVP, Payment Integrity, A National Health Plan

By partnering with best-in-class technology to improve our payment integrity operations, we were able to ensure compliance and reduce medical spend resulting from overpaid claims.

The ClaimShark platform has resulted in significant cost savings and efficiency improvement for us.

– EVP, A National Health Plan

While we have a great team, we were handicapping them with a lack of technology leading to a highly manual process. We partnered with ClaimShark to modernize our COB operations, increase overpaid claim identification with a goal to bring automation and reduce manual intervention.

– AVP, Payment Integrity, Leading National Health Plan

PLATFORM OVERVIEW

savings
Increase Savings
costs
Decrease Costs
appeals
Reduce Appeals
insights
Better Insights
platform

BASE PLATFORM

MODULES
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Data Integration Hub check check
Comprehensive Claim Inventory Management check check
Clinical Chart and Document Repository check check
Rules, Edits, and Workflows check check
Analytics, Dashboards, and Reports check check
Letter and Provider Communication Management check check
Appeals Workflow and Management check check
Artificial Intelligence & Machine Learning check check
speciality

SPECIALITY

MODULE TYPES
 Vendor and Audit Concept Management check
Clinical and DRG Audit check
Coordination of Benefits (COB) check
High Dollar Audit check
Itemized Bill Review Audit check
Quality, Compliance and SLA Audit check
Provider Contract Audit check

HOW CAN WE ASSIST YOU?

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