Payment Integrity Provides A More Precise Approach to Identifying Claim Payment Errors

Healthcare spending has exceeded $3 trillion annually. Despite considerable gains in claims payment validation, over $100 billion in wasteful spending still occurs each year. Healthcare claims processing is as profoundly complex as ever and is only made more difficult by numerous EMR vendors and compliance issues.

Through proven audit practices, Consova identifies and recovers overpayments caused by inaccurate contract re-pricing, improper coding and misapplied reimbursement methods. The combination of expert auditing and coding staff coupled with Consova’s Precision Analytics® technology enables Consova to rein in wasteful spending and recover lost healthcare dollars. On average, our process identifies 3-5% of claim payments as payment errors.

Overpayment and Recovery

To stop profit leakage and improve bottom line performance, payers need to take a new approach to payment integrity. This is where Consova’s diligent, thoughtful approach to retrospective claims accuracy comes into play. Our team of industry veterans dig deep to find overpayments and recover the funds,while respecting your sensitive provider relationships.

Our payment integrity solutions complement your existing reviews with a more thorough examination that often uncovers additional recovery opportunities. Our analysis includes everything from identification and financial resolution to root cause analysis and prevention, resulting in millions of dollars in savings for our payer clients.

Consova identifies a wide variety of improperly paid claims, including:

  • Contractual Errors
  • Coordination of Benefits
  • Duplicate Payments
  • Eligibility
  • Improper Discounts/Allowances
  • Benefit Audits
  • TPL Audits

We perform in-house collections and utilize partnerships to recover every dollar possible for you. Our main collection partner collects 75% of every identified dollar within 180 days.

Finding Dollars Others Miss

Since 2003, Consova has been out-thinking and out-working the competition. We challenge payers to put their existing auditors to the test by allowing Consova to be the sweeper, even if that has to be on a 100% contingency basis. We will prove our approach to payment integrity is superior by finding payment errors that first and second pass auditors overlook or cannot fathom.

Credit Balance Audit

With Consova’s Credit Balance service, we identify revenue leakage and recapture the lost dollars to the payers through identifying insurance overpayments and claims errors. We preserve your relationship with providers and operate as an independent third party to identify, collect and return payment errors. All of our credit balance and recovery services are offered at no direct cost to the providers. In the convoluted corporate space, a major benefit of partnering with Consova is that we are not affiliated or owned by a health insurance carrier, guaranteeing there is no conflict of interest, and your confidential claims data is not shared with a competitor.

Consova conducts on-site or remote credit balance recovery audits to assist insurers in the identification and recovery of errant claims. Our unique Consova Precision Analytics® technology enables us to garner higher quality identification and recoveries than the competition, taking measures to prevent future credit balance issues from reoccurring. Through our comprehensive credit balance service, we identify:

  • Refunds for CMS and Insurers
  • Insurance Overpayments
  • Underpayments
  • Non-cash Adjustments
  • Patient Refunds

Committed to Security

Consova is leading the industry when it comes to security. Consova maintains SSAE 16 SOC 2 Type II Certification, demonstrating its controls as a service organization relevant to security, availability, processing, integrity, confidentiality and privacy. Additionally, independent HITECH/HIPAA reviews are conducted to ensure our practices, procedures, policies, system architecture and encryption technologies protect the privacy and confidentiality of sensitive employee data.


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