Helping payers realize greater efficiencies

As a trusted IT services partner to healthcare payer organizations, CGI builds and manages business, clinical and IT solutions for our clients’ most complex and mission-critical operations.

  • CGI ProperPay claims fraud, waste and abuse solution and services have helped government and commercial payers predict, identify and recover more than $2.1 billion in lost payments due to improper medical and pharmacy claims in the last 5 years alone.

  • CGI’s HotScan Watch List filtering software scales to scan all payments and customer data, provides notifications of matches against watch lists and meets the constantly rising regulatory compliance bar.

  • Payment reimbursement methodologies solutions help payers implement effective prospective payment processes to manage inpatient, outpatient and professional reimbursements.

  • Healthcare value optimization and prescriptive analytics capabilities shift the use of analytics from monitoring and reporting what has happened, to using prescriptive analytics to make decisions, whether based on payment or claims insights to improve member outcomes and experiences, or financial insights for better planning and forecasting accuracy.

  • Call center operations provide state of the art services, including bilingual support and access to translators speaking over 200 languages.

  • Payer administrative system modernization services that include core administration services for enrollment, premium billing, member services, claims, provider relations, printing and fulfillment.

  • Patient-centric care management solution brings together data and systems for home health monitoring, care planning, and workforce and ambulance dispatch with CGI CommunityCare360.

  • Information technology services align payers’ business and IT strategies, allowing clients to become more efficient and productive, while improving quality of care.