Payer Solutions

An organization’s ability to learn, and translate that learning into action rapidly, is the ultimate competitive advantage.

We’ve all heard the numbers…

In 2018, $3.6 Trillion was spent on health care in the United States, representing billions of health insurance claims. It is an undisputed reality that some of these claims are fraudulent. Those fraudulent claims carry a very high price tag, both financially and in how they impact our perception of the integrity and value of our health care system.

Trillion Spent on Healthcare in the US yearly

%

Minimum goes right out the window to FWA. So thats...

Billion dollars lost to Fraud, Waste and Abuse

%

Could be closer to the real number. So thats about...

Billion in losses yearly

We Know What Works, And What Doesn’t.

After working with a variety of commercial and government payers for close to 20 years, we have seen what works and what wastes time and money. Your relationships with members and providers are important.

Our team has expanded our model of coding and billing audits focused on waste and abuse to better support your program integrity efforts.

What We Do

A combination of technology and healthcare IQ.
Our goal is to pay for ourselves and then some.

Covid Support

Advize Health assists SIU teams with data analytics, investigations, and probe and statistical sampling for COVID-19 fraud. Our retired OIG agents, Certified Professional Coders (CPC) and Correct Documentation Improvement (CDI) professionals have the expertise needed to identify the schemes being performed and are closely connected to those in the field conducting these investigations.

Medical
Record Review

Payers can minimize this risk with Advize Health. Our cost-effective and efficient medical record review services identify inconsistent documentation between clinical records and claim payment data. Our highly-skilled team of experts has performed coding and billing audits in both private and public sectors (state, RAC, and CMS) for a combined total of nearly 225 years, and has a range of certifications, including: RN, CPC, CPC-H, CPC-I, CCS-P, CIRCC, CPCO, CPMA, CEMC, CHC and CFE.

Consulting Services

The Advize Health focus extends beyond medical record reviews into the following services to help organizations deliver better healthcare:

  • Policy and Procedures
  • Education and Training
  • Risk Adjusted Rating
  • Medical Necessity
  • Over-Utilization
  • Dental

Education & Training

The Advize Health focus extends beyond medical record reviews into the following services to help organizations deliver better healthcare: Policy and Procedures Education and Training Risk Adjusted Rating Medical Necessity Over-Utilization Dental Education Healthcare fraud schemes can range from simple to very complex. Doing your job efficiently is just as important as doing it effectively. We customize education for teams large to small, covering everything from effective documentation management and maintenance to the best practices when interviewing.

Let's goooooo!

We are currently accepting new projects.  Need some help?  Just want to chat?  We are really easy going.  No tracking devices we promise.

Corporate Office

4550 N. Palmetto Ave, Unit 102
Winter Park, FL 32792

813.569.2352
888.722.6059