At CGI, we design our payment integrity consulting services to address our clients' most pressing challenges and capitalize on critical opportunities. We specialize in clinical collaboration, process optimization, insourcing, training and reimbursement policy building. Known for our holistic approach, we leverage extensive functional expertise to bridge gaps and integrate efforts across organizational boundaries and silos.
Our clear vision and ability to deliver results have made us the partner of choice for commercial health and government healthcare payers and insurers as well as emerging partner for providers.
Our team of specialized industry experts brings more than 30 years of experience in analyzing and auditing government health plans, managed care and private insurance medical data. Our team includes clinicians, data scientists, health information management professionals, payment integrity operations specialists, claims operations specialists and IT experts that bring business experience from relevant healthcare payer industries. We blend staff members from systems, claims, payer, provider and clinical backgrounds to develop innovative solutions that are effective and produce results.
We work closely with our clients’ clinical teams to align payment processes with clinical practices and documentation. Through this collaboration, we help clients identify and correct discrepancies between clinical documentation and billing, ensuring that claims are accurate, compliant and fully supported by the medical record.
We develop and document robust workflows for claims processing, including validation and approval stages. Clear key performance indicators (KPIs) are defined, and consistent reporting mechanisms are implemented to monitor progress, uncover improvement opportunities and drive continuous optimization.
Insourcing your payment integrity value streams is complex and requires a long-term roadmap. Leveraging our proven Payment Integrity Maturity Path scale, we look at your people, processes and technology to identify your current state and recommend actionable next steps to create a comprehensive, high-performing program.
With over 30 years of staffing and training clinicians and coders for payment integrity audits, we leverage this expertise to hire and train your team of auditors to support an insourcing journey. We also offer targeted training sessions on specialized topics to enhance the skills of your existing audit teams.
Implementing these outcomes can significantly transform healthcare operations. By improving claim billing and payment accuracy, organizations can reduce denials and enhance regulatory compliance. This, in turn, boosts financial performance and efficiency through automation. Identifying and closing gaps, along with creating strong internal audit teams, ensures robust oversight and continuous improvement. Additionally, these measures foster improved provider relationships, creating a more collaborative and effective healthcare environment.
Our clear vision and ability to deliver results have made us the partner of choice for healthcare payers and insurers. As your strategic partner, we focus on optimizing and supporting your payment integrity program and drive the following outcomes:
Connect with our team to learn how we specialize in clinical collaboration, process optimization, insourcing, training and reimbursement policy building.
