A large U.S. commercial healthcare payer / insurer needed claims audit software to efficiently and effectively identify and recover improperly paid claims and overpayments.

The client chose our CGI ProperPay solution to identify improper claims and restructure their auditing process, while implementing a case management module to support their fraud, waste and abuse investigation / audit efforts.

Value delivered

  • Identified and recovered more than $200 million in improper payments
  • With a strong focus on Inpatient DRG claims, streamlined the reporting process for all groups and created an efficient common workflow
  • Continued to conduct ongoing meetings to refine both the edit library and new opportunities


Learn more about CGI's Payment Integrity Services

CGI’s innovative suite of payment accuracy solutions delivers the best complex-audit-review overturn rates in the market, along with proactive feedback to prevent future errors, enabling payers / insurers to continuously ensure claims payment accuracy while maintaining the highest level of compliance.