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Fast track to ROI

Phase One

Line drawing of many cubes connected by short sticks to each other to form a model.

Data Preparation & System Configuration

It’s all about the essentials

Together, we’ll hit the ground running by evaluating your data while learning about your commitments. Your data will be handled securely and in compliance with HIPAA. We’ll learn how to interpret your unique claims and provider data and incorporate how you address your company’s line of business policies, provider contracts, industry standards (NCCI, HCPCS, CPT), state guidelines, the Centers for Medicare and Medicaid Services (CMS) regulations – and more.

You Provide

  • Ongoing data feed
  • Configuration checklist of business requirements

We Deliver

  • AArete best-in-class methodology and market intelligence

Phase Two

Many small cubes of various sizes scattered across a stylized background.

Building Models and Edit Configuration

It’s all about building in quality

During this time, the AArete team is leveraging your data using Payment Intelligence® to build quality and consistency with your business requirements. Using rules-based analytics and artificial intelligence (AI), AArete configures rules and develops unique models to support your needs.

You Provide

  • Business requirements calls for additional clarifications

We Deliver

  • Subject matter experts to manage and monitor the rules and models
  • Data enrichment
  • Quality assurance testing
  • Vetting of initial results

Phase Three

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Testing & Validation

It’s all about getting it right

Together, we’ll fine-tune the Payment Intelligence® edits and models, testing each and every individual change. Getting it right for you is essential to your success. At the end of this phase, you are ready to begin to gain value from your investment.

You Provide

  • Testers for user acceptance
  • Scrub calls for feedback
  • Validation of opportunities

We Deliver

  • Finely-tuned models & edits
  • Robust reporting & results measurement

Phase Four

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Opportunity Pipeline & Continuous Learning

It’s all about optimizing results

We continue to add new layers of intelligence with additional models. Ultimately, helping you achieve a steady state through the ongoing identification of actionable findings to maximize the return on your investment.

You Provide

  • Decisions for automated acceptance
  • Ongoing feedback & review of findings
  • Adjust claims for opportunities

We Deliver

  • Subject matter expertise
  • Ongoing presentation of recoupable findings
  • Machine learning & additional models
  • Insights into optimization
  • Root cause remediation
Payment Intelligence Insights

Information and insights for health plan leaders

How much could you improve the profitability of your health plan?

There are many moving parts that can effect your bottom line. What happens if you tweak your process? Check out this calculator to identify the potential for you.

Calculate Opportunity