Join us at the 7th Annual Healthcare Payment & Revenue Integrity Congress returning in Nashville!
Whether you’re looking for vendors with proven ROI or insourcing strategies from health plan leaders, this event has it all. Explore AI-driven solutions for improving data analytics, reducing FWA, and enhancing claims accuracy. Network with peers and collaborate with providers to drive efficiency and financial success for your plan!
WHY HPRI
POST EVENT REPORT
Are you interested in learning about the key takeaways from HPRI South in Miami, Feb 2024? Download the post event report to:
- View the list of companies in attendance
- Hear what health plans thought of the event
- Read takeaways on the biggest priorities for the market
- Discover what is next in the series
DON'T TAKE OUR WORD FOR IT
This was a great event to bring together all of the key players of payment integrity to collaborate and learn from one another.
Outstanding opportunity to collaborate with other medical directors and vendors. The small forum allowed for more indepth discussions in an informal environment.
This event was great for networking. There were some of the best vendors in the industry, and there was a good mix of representation from the payer side.
The insights gained from HPRI South spotlights key changes in the industry and provides a roadmap for developing a strategy for success for our company. The domain expertise, decision makers in attendence, and ability to have meaningful exchange of ideas, makes this the an event that PI amd RCM professionals must attend.
It is a great community and a great meeting. I would encourage anybody in the PI space to get out here.
How To Get Involved
Partner With Us
Partner with us to elevate your brand, and make valuable new connections. Subject to availability, we offer opportunities for thought leadership, branding, and facilitated networking.
Please contact our Partnerships Director, Harry Ludbrook, for more information. [email protected].
Register your free place
Step into interactive discussions and engaging presentations on the key challenges and opportunities presented by payment companies.
Healthcare Payers & Providers can attend for free.
Featured Speakers
Dr Priscilla Alfaro, MD, FAAP, CPC, CPMA, COC, CIC, CFE
David Flannery
David Flannery is a "pioneer" in telemedicine, having started telegenetics clinic in 1995 in Georgia. He’s currently the Director of Telegenetics and Digital Genetics at Cleveland Clinic. He has expertise with ICD-10 coding and CPT codes. He oversaw the revenue cycle management for the 300+ physician practice group at the Medical College of Georgia. He served on the American Medical Association's Digital Medicine Payment Advisory Group, developing new CPT codes for telemedicine and digital medicine.
Dr. Ahmad Kilani MD, MBA, MLS, MSIT, CHCQM-PHYADV, FACP, FACHE
Anthony Baize
Anthony Baize has been the Inspector General for the Wisconsin Department of Health Services since 2016. He holds a master's degree in public administration from Indiana State University and a Certified Inspector General (CIG) credential from the Association of Inspectors General. Prior to joining Wisconsin state government, Baize was the deputy director of audits and investigations for the Office of the Inspector General for the Kentucky Cabinet of Health and Family Services.
Rae A. McIntee, DDS, MD, MBA, FACS, CPE
Kelly Springmann
26% of health plans identify access to quality data as their biggest challenge
Understand the several critical points for payers in the healthcare sector as they navigate the complexities and opportunities of 2024 considering the evolution of payment integrity, opportunities with AI implementation and impact of financial pressures.
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"The HPRI event's are great. I enjoy the presentations, opportunity to meet with vendors and network with other payers and providers."Monique Pierce, Head of Payment Integrity joined Devoted Health in 2020 with the goal of building the first ever integrated Payment Integrity Program. She shares her experiences, wins and challenges at the HPRI events.
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Navigating the Payment Integrity Vendor landscape with usThe ultimate guide to who’s who in the payment integrity vendor space – to help you choose the best option for your business.
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Looking for tips and tricks on how to develop your payment integrity strategy in 2024?We met with leader Dr. Michael Seavers from Harrisburg University of Science and Technology on where to start when it comes to addressing your current strategy to ensure you are working efficiently.
How To Get Involved
Partner With Us
Partner with us to elevate your brand, and make valuable new connections. Subject to availability, we offer opportunities for thought leadership, branding, and facilitated networking.
Please contact our Partnerships Director, Harry Ludbrook, for more information. [email protected].
Register Your Free Place
Step into interactive discussions and engaging presentations on the key challenges and opportunities presented by payment companies.
Healthcare Payers & Providers can attend for free.
OUR COMMUNITY OF PAYERS AND PROVIDERS
Step into interactive discussions and engaging presentations on the key challenges and opportunities presented by payment companies today:
OUR PARTNERS
AUDIENCE BREAKDOWN
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Healthcare Payers/ Insurance Companies40%
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Healthcare Providers20%
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Payment Integrity Vendors30%
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Claims Processing10%
OUR SELECTION COMITTEE
Brannon Morisoli
Mr. Morisoli joined SWK Holdings as a Senior Analyst in March 2016. Prior to joining SWK, he was an Investment Analyst and Portfolio Manager for a family office that invested in equities, fixed income, real estate, and alternative investments. Prior to that, he was an Investment Analyst for Presidium Group, a real estate private equity firm, where he played an integral role in closing over $100mm in transactions. Mr. Morisoli began his career at Neurografix, a startup medical technology company in Santa Monica, CA that was doing groundbreaking work in the MRI imaging of peripheral nerves. While with Neurografix, he was published in two leading neurology journals. Brannon graduated from UCLA with a B.S., was awarded a fellowship and graduated from the University of Notre Dame with an M.B.A, and was awarded a Samson Fellowship from the University of Wisconsin Law School, where he graduated with a J.D. Mr. Morisoli is an inactive member of the State Bar of Wisconsin
Thomas Busby
Thomas Busby is a Vice President and has been with Outcome Capital since 2015. He focuses on medical technology, digital health and life science services segments with particular interest in innovative life science companies that deliver patient impact by leveraging novel approaches. Thomas is driven by the desire to identify disruptive technologies and services that require unique strategic thought and assistance to realize their full market potential. Thomas has been published in leading life science journals Life Science Leader and The Pharma Letter, and also serves on the board of HealthTech Build, a Boston-based digital health innovation group.
Prior to his career in life-science investment banking, Thomas pursued his passion for the public service and non-profit sectors working in a variety of leadership and management positions, and at one time held a Massachusetts teaching license.
Thomas completed his MBA at Suffolk University’s Sawyer Business School on full academic scholarship where he was President of the school’s Graduate Business Association and class speaker at graduation. Prior, he completed a BS in Philosophy with Honors from Suffolk’s College of Arts & Sciences. Committed to giving back, Thomas is currently the President of the College of Arts & Sciences Alumni Board of Directors. Thomas is a FINRA Registered Securities Representative holding his Series 79 and 63.
Robert Crousore
Robert has 28 years of experience in the health care products and
services industry. Crousore is a serial entrepreneur with multiple
successful product and services company exits. His experience spans
the entire business enterprise including Sales, Marketing, Operations,
Product Innovation and, most recently M & A.
Highlights Include:
- Has successfully managed a global commercial organization in the wound care business.
- Has a number of patent credits for products in the wound care industry.
- Sits on multiple boards of healthcare technology companies.
- His passion is creating meaningful changes in patient care by combining great products with great teams that are focused on empowering improved clinical and financial outcomes.
Brannon Morisoli
Mr. Morisoli joined SWK Holdings as a Senior Analyst in March 2016. Prior to joining SWK, he was an Investment Analyst and Portfolio Manager for a family office that invested in equities, fixed income, real estate, and alternative investments. Prior to that, he was an Investment Analyst for Presidium Group, a real estate private equity firm, where he played an integral role in closing over $100mm in transactions. Mr. Morisoli began his career at Neurografix, a startup medical technology company in Santa Monica, CA that was doing groundbreaking work in the MRI imaging of peripheral nerves. While with Neurografix, he was published in two leading neurology journals. Brannon graduated from UCLA with a B.S., was awarded a fellowship and graduated from the University of Notre Dame with an M.B.A, and was awarded a Samson Fellowship from the University of Wisconsin Law School, where he graduated with a J.D. Mr. Morisoli is an inactive member of the State Bar of Wisconsin
Thomas Busby
Thomas Busby is a Vice President and has been with Outcome Capital since 2015. He focuses on medical technology, digital health and life science services segments with particular interest in innovative life science companies that deliver patient impact by leveraging novel approaches. Thomas is driven by the desire to identify disruptive technologies and services that require unique strategic thought and assistance to realize their full market potential. Thomas has been published in leading life science journals Life Science Leader and The Pharma Letter, and also serves on the board of HealthTech Build, a Boston-based digital health innovation group.
Prior to his career in life-science investment banking, Thomas pursued his passion for the public service and non-profit sectors working in a variety of leadership and management positions, and at one time held a Massachusetts teaching license.
Thomas completed his MBA at Suffolk University’s Sawyer Business School on full academic scholarship where he was President of the school’s Graduate Business Association and class speaker at graduation. Prior, he completed a BS in Philosophy with Honors from Suffolk’s College of Arts & Sciences. Committed to giving back, Thomas is currently the President of the College of Arts & Sciences Alumni Board of Directors. Thomas is a FINRA Registered Securities Representative holding his Series 79 and 63.
Robert Crousore
Robert has 28 years of experience in the health care products and
services industry. Crousore is a serial entrepreneur with multiple
successful product and services company exits. His experience spans
the entire business enterprise including Sales, Marketing, Operations,
Product Innovation and, most recently M & A.
Highlights Include:
- Has successfully managed a global commercial organization in the wound care business.
- Has a number of patent credits for products in the wound care industry.
- Sits on multiple boards of healthcare technology companies.
- His passion is creating meaningful changes in patient care by combining great products with great teams that are focused on empowering improved clinical and financial outcomes.
PREVIOUS INDUSTRY LEADING SPEAKERS
Dr Priscilla Alfaro, MD, FAAP, CPC, CPMA, COC, CIC, CFE
David Flannery
David Flannery is a "pioneer" in telemedicine, having started telegenetics clinic in 1995 in Georgia. He’s currently the Director of Telegenetics and Digital Genetics at Cleveland Clinic. He has expertise with ICD-10 coding and CPT codes. He oversaw the revenue cycle management for the 300+ physician practice group at the Medical College of Georgia. He served on the American Medical Association's Digital Medicine Payment Advisory Group, developing new CPT codes for telemedicine and digital medicine.
Dr. Ahmad Kilani MD, MBA, MLS, MSIT, CHCQM-PHYADV, FACP, FACHE
Anthony Baize
Anthony Baize has been the Inspector General for the Wisconsin Department of Health Services since 2016. He holds a master's degree in public administration from Indiana State University and a Certified Inspector General (CIG) credential from the Association of Inspectors General. Prior to joining Wisconsin state government, Baize was the deputy director of audits and investigations for the Office of the Inspector General for the Kentucky Cabinet of Health and Family Services.
Gregory Bryant
Richelle Marting, JD, MHSA,RHIA,CPC,CEMC,CPMA
Novelette Wallace, MPH, PMP, CSSBB
Novelette Wallace is a distinguished Payment Integrity Leader with a rich background spanning over 30 years in the healthcare industry. Her extensive experience includes leadership roles within payment integrity, where she has played pivotal roles in both payment integrity vendor organizations and health plans. Throughout her career, Novelette has demonstrated a remarkable ability to build and lead Payment Integrity departments from their inception. Her expertise has been instrumental in establishing robust processes and strategies to identify and recover inaccuracies in claims, contributing significantly to cost of care savings for health plans year after year.
Novelette has held key leadership positions with industry-leading organizations, including Performant Corp, United Healthcare, and Aetna (previously Coventry). In each role, she has consistently delivered results by optimizing payment integrity processes and driving operational excellence. Currently serving as the Assistant Vice President (AVP) of Payment Integrity for Johns Hopkins Health Plans, Novelette continues to bring her wealth of knowledge and leadership acumen to the forefront. Her dedication to achieving and surpassing cost of care savings goals exemplifies her commitment to advancing the financial health and efficiency of healthcare organizations.
With a proven track record of success and a comprehensive understanding of payment integrity within the healthcare landscape, Novelette Wallace stands as a respected leader in the industry, contributing significantly to the success of the organizations she serve
Dr Deepak Goyal, MD, MBBS, MBA, CPE, CHCQM, CMRP, CMPC
Dr Brad Archer
Kelly Bennett, JD, CFE, AHFI
Jenny Raulerson, BSN, MSHI
Kelly Springmann
Rae A. McIntee, DDS, MD, MBA, FACS, CPE
Colleen Gianatasio
Colleen is a strategic clinical documentation, coding and compliance, and risk adjustment expert with 10+ years of experience driving increases in provider engagement. She has thoughtfully built clinical documentation improvement programs from scratch to target accurate risk scores, increases in provider satisfaction, and cost-savings.
Beyond her role at CDPHP, Colleen is also currently the president of the AAPC National Advisory Board.
Monique Pierce
Monique is a Strategic Executive Healthcare Leader with proven ability to develop solutions and maximize the benefits of Payment Integrity programs. She is known for having excellent domain knowledge and being driven, high performing, and having a deep dedication to recruiting and developing top talent.
Monique started her Payment Integrity career at Oxford HealthPlans in the COB and Subrogation Department after spending time in Payment Policy. When United Healthcare acquired many health plans in the early 2000s like Oxford, Monique was tagged as part of the Optum team to integrate the processes and people into the COB systems that she had built at Oxford. She led systems development, quality, reporting, operations, vendor management and was responsible for creating innovative proactive programs that more than doubled savings to $1.4B in three years.
Monique developed a successful program that reduced interest expense on late claims for UHC, assisted a communication company to develop COB tools and assisted in strategic system projects before joining SCIO Health Analytics in 2014 to develop new products - specifically prepayment programs.
In 2015 she became the product owner of SCIOMine, the company’s internal audit application and managed the roadmap. Monique also owned
strategic direction for operational metrics and reporting including executive scorecards. Monique was promoted to VP of Business Opportunities and Client Engagement where she improved Audit Recovery TAT by 39% and reduced client implementations TAT by 11% and the Level of Effort by 18% while increasing the count of implementation projects by 126%.
In 2020 Monique joined Devoted Health, a startup company with the goal of building the first ever integrated Payment Integrity Program. The company has one system, great data, and a great mission; to change health care by treating every member as if they are family.
In her spare time, Monique volunteers her time in the community on the Board of Directors of SCARE NH and works in her family business LARP Portal with her husband Rick.
David Ott
David Ott has over 28 years of experience in the healthcare and financial services industries. David has provided leadership and direction to department leaders and teams that support a variety of functions, including business development, payment integrity, claims processing, global project management and quality practices.
Karen Ballard
Karen Ballard is Director of Consulting Services, CGI, where she is responsible for managing the CGI ProperPay payment integrity platform. With a nearly 20-year career in the health payer space, Karen possesses a deep knowledge of claims processing, product management, payment integrity, and the Blue payer dynamic. Prior to joining CGI, Karen held a variety of positions in claims operations, BlueCard, and payment integrity during her 17-year tenure with Elevance Health (Anthem).
Karen holds a Bachelor of Arts and a Master of Business Administration from Southern New Hampshire University. She co-founded and previously co-facilitated the Blue PI Committee, comprised of payment integrity leaders from all 33 Blue Cross and Blue Shield plans and partnered with the Blue Cross and Blue Shield Association to drive change in the payment integrity space.
Aaron Browder
Aaron Browder is Staff Vice President, Elevance Health and President, Carelon Subrogation, formerly Meridian Resource Company (Meridian), where he and his team are responsible for overseeing the successful implementation and execution of our clients’ end-to-end subrogation programs. With a nearly 20-year career in subrogation, Aaron possesses a deep knowledge of healthcare subrogation. He has held a wide range of management positions throughout his tenure at Meridian, most recently serving as Staff Vice President. Prior to joining Meridian, Aaron gained experience in the financial services and insurance industries with Arthur Andersen, LLP/KPMG, LLP, and Travelers Property Casualty.
Aaron holds a Bachelor of Arts degree from Indiana University and a Master of Business Administration from Butler University. He served on the Board of Directors for the National Association of Subrogation Professionals and has been a national presenter and author on issues related to subrogation.
Sherri Richardson
As a strategic leader in Program Integrity Health Insurer industry and having mastered the world of “coordination of benefits”, Sherri is passionate about helping our customers and peers navigate the complex world of healthcare. With a proven track record of success in optimizing program efficiency and minimizing cost of care for Members who are eligible/entitled to two health coverages, Sherri is dedicated to ensuring the industry processes are focused on minimizing members out of pocket and provider/insurers administrative costs.
Sherri has 30+ years Health Insurer Industry experience. Operational Excellence, mapping program Strategy is Her Leadership background includes leading highly productive operational teams and all functions of COB Operations within the Commercial, Medicare, Affordable Care Act, Medicaid, Subrogation and Senior market.
As an Elevance/Carelon Corporate Presenter, Sherri enjoys developing training and motivational material, as well as sharing her knowledge and best practices related to maximizing Health Coverage with members, groups, providers and other insurer peers.
Sherri’s experience in health insurance runs deeps, having the privilege of leadership at Elevance/Carelon for 30+ years, and mentoring from industry leaders. Sherri is a life-long learner and strongly encourages others to learn and grow through continued experiences and educational opportunities.
On a personal note; As a prior Fitness Trainer, Sherri enjoys Weight Training, Yoga, Aerial Silks, and Master Swimming. Oftentimes joins the local 5K runs and loves to cook.
Kyle Pankey
Kyle Pankey has over two decades of experience working within the healthcare and payer operations, with over 10 years specifically tied in to the payment integrity space. Kyle lives in Chattanooga, TN and has served as Carelon Subrogation’s growth leader since mid-2022.
Dr. Michael Menen
Karen Weintraub
With 25 years of data and 20 years of healthcare experience, Ms. Weintraub is currently responsible for the design and development of the company’s healthcare fraud detection software products and services. She provides subject matter expertise on system design and workflow, business rule development, data mining and fraud outlier algorithms as well as SIU policies and procedures. Prior to joining Healthcare Fraud Shield, managed SIUs on various healthcare investigations for all commercial, Medicaid and Medicare business and claims of fraudulent activity. Ms. Weintraub received a BA in Criminal Justice from the University of Delaware and an MA in Criminal Justice from Rutgers University. Ms. Weintraub is a Certified Professional Coder for Payers (CPC-P), a Certified Professional Medical Auditor (CPMA) from the American Academy of Professional Coders, a Certified Dental Coder (CDC) from the American Dental Association, and the founder of the Hamilton, NJ AAPC chapter. She is also an Accredited Healthcare Fraud Investigator (AHFI) from the National Healthcare Anti-Fraud Association (NHCAA). Ms. Weintraub Taught CPT Coding, Fraud & Audits, and Medical Billing, Laws and Ethics and the local community college.
Lacey Crowl
Lacey Crowl is the Director of Claims Operations for Longevity Health Plan, responsible for the accuracy of claims processing focused on Medicare members. Lacey has experience in the Commercial, Medicare and Medicaid environments, developing prospective and retrospective payment integrity solutions for both clinical and claim coding reviews. She has operated within various claims processing platforms to develop, code and implement new audit concepts while operating within the Managed Care space.
Matt Ruyter
Mike Spellman
Toni Case
Lawrence M. Simon, MD, MBA, FACS
Dr. Larry Simon is the Interim Senior Medical Director and Managing Medical Director for Medical Policy and Medical Appeals for Blue Cross and Blue Shield of Louisiana (BCBSLA), where he also serves as the Medical Director for Coding and Reimbursement and Chair of the Credentialing and Medical Quality Management Committees. He is a member of the AMA CPT Editorial Panel, serving on the Executive Committee and as Co-Chair of the Molecular Pathology Advisory Group and Genomic Sequencing Procedures Workgroup. He also chairs the Medical Director’s Forum for both the Louisiana Association of Health Plans and the National Anti-Fraud Advisory Board of the Blue Cross and Blue Shield Association. Prior to joining BCBSLA, Dr. Simon served in numerous leadership roles for the American Academy of Otolaryngology, the American Medical Association, the American College of Surgeons, and the Louisiana State Medical Society.
Dr. Simon is an alumnus of Louisiana State University, Baylor College of Medicine, Rady Children’s Hospital, and the BI Moody College of Business Administration at the University of Louisiana. A diplomate of the American Board of Otolaryngology and a Fellow of the American College of Surgeons, Dr. Simon has over 15 years of experience in Health Policy and Healthcare Reform, and he has presented over 170 lectures and seminars on these topics.
A Rotarian, an animal rescuer, a member of multiple civic boards, and a patron of the arts, Dr. Simon enjoys spending his time outside of work serving his community, helping the animal shelters and abandoned dogs of Louisiana, and travelling and enjoying life with his wife and their family and friends.
Alan Coulter
Ray Evans
Ray Evans is a dynamic business development executive with extensive experience working within, and servicing healthcare organizations. He holds the position of Vice President of Healthcare Sales at CoventBridge Group where he utilizes his experience to share with the industry CoventBridge’s unmatched FWA investigative solutions. His goal is to work with health plans in protecting their organization from FWA through an experienced, flexible, and sensitive approach to minimizing provider abrasion, while still achieving organizational objectives.
Amy Anzola, RN, MSN
Brad Ross
David V. Cardelle, R.Ph.
John-Michael Loke
Chandra Kuti
Ram Davaloor
Rena Bielinski
Jesse Montgomery
CONFERENCE PACKAGES
- Thursday, August 15, 2024 to Thursday, February 6, 2025Healthcare Payers & ProvidersCOMPLIMENTARY PASSAn organization that determine service prices, collect payments, and handle claimsA legal entity, or sub-set of a legal entity, which may contract for the provision of health care
- Thursday, August 15, 2024 to Thursday, February 6, 2025Vendors/Solution Providers$5,499Standard ratePayment Integrity VendorsRevenue Integrity VendorsConsultantsAnyone that provides a product or service to payers/providers
MEDIA KIT
For more information on webinars, roundtables, content marketing packages, interviews and marketing solutions opportunities, download the Media Kit.
If you have any questions, please contact Harry Ludbrook, Sales Director, [email protected].
HEADLINE PARTNER
AMS Intelligent Analytics
Website: http://www.amspredict.com/
Advanced Medical Strategies (AMS) is the premier provider of payment integrity, risk management, and business intelligence solutions to identify and address excessive claims, prevent and recoup overpayments, and effectively manage the risks associated with high-cost claimants and group health underwriting.
GOLD PARTNERS
Carelon
Website: https://www.carelon.com/
The health of the healthcare system improves when spending is responsible and accurate. Today, platform technology and advanced analytics are paving the way to make that more efficient and more proactive than ever before. Backed by decades of experience, Carelon’s Payment Integrity solutions bring together breakthrough technology and human expertise to help speed your ability to drive cost savings and value for your stakeholders.
MedReview
Website: https://www.medreview.us/
Headquartered in the financial district of New York City and serving all U.S. states and territories, MedReview has been a leading provider of payment integrity, utilization management and quality surveillance services for more than 40 years. A physician-led organization with a passion for ensuring that health care claims fairly represent the care provided, MedReview provides timely independent hospital billing audits and clinical validation reviews on behalf of health plans, government agencies and Taft-Hartley organizations, saving millions of dollars for its clients each year.
Community Partner
Performant
Website: https://www.performantcorp.com/home/default.aspx
Performant Healthcare Solutions is a leading independent provider of technology-enabled audit, recovery, and analytics services in the United States with a focus in the healthcare payment integrity industry. Performant works with healthcare payers through claims auditing and eligibility (coordination of benefits)-based services to identify improper payments. The Company’s commercial health plan clients include both national and regional payers that represent more than 100 million covered lives across all lines of business, including commercial, Medicare, and Medicaid coverages. Performant also supports numerous engagements with the Centers for Medicare & Medicaid Services, including multiple Recovery Audit Contractor contracts and the Medicare Secondary Payer Commercial Repayment Center contract, as well as a contract with the US Department of Health and Human Services, Office of the Inspector General for complex claim review nationwide. The Company also features a call center to serves clients with complex consumer engagement needs.
Powered by a proprietary analytic platform and workflow technology, Performant also provides professional services related to the recovery effort, including reporting capabilities, support services, customer care, and stakeholder training programs meant to mitigate future instances of improper payments. Founded in 1976, Performant is headquartered in Livermore, California. Visit www.performanthealthcare.com and follow us on Twitter: @PerformantCorp.
Shift Technology
Website: https://www.shift-technology.com/en-gb/
Please visit our website for more information.EVENT PARTNER
4L Data Intelligence
Website: https://4ldata.com/
4L Data Intelligence™ uses the patented power of Integr8 AI™ to find, fight and prevent fraud, waste, and abuse fast with the revolutionary provider-centric FWA approach. Integr8 AI technology, coupled with our continuously credentialed provider database, detects FWA you can’t see with claim data-centric approaches, solving a challenge every payment integrity platform has today.
The 4L FWA Prevention™ solution rapidly detects and prevents FWA at five points across the claims management workflow including pre pre-payment, pre-payment and post-payment positions. At each point, Integr8 AI dynamically and continuously detects provider behaviors, relationships, and outlier status without the limitations of rules-based and claim data-centric solutions. In short, it enables you to see what providers are doing individually, in relationship with all other providers, and in relationship to all other claims on each-and-every claim submitted.
4L FWA Prevention pre-payment and post-payment detection and prevention results are delivered in four distinct categories. These are:
- Provider Integrity Edits
- Adaptive Claims Edits
- Provider Behavior Analysis
- Provider Schemes Analysis.
For fraud and SIU teams, Integr8 AI detects fraud and collusion schemes you can’t see now, or can’t see fast enough, with claim-centric approaches. Our suite of tools automates continuous near real-time SIU-in-a-box detection and documentation so you can Find, Fight and Prevent Fraud Fast™.
Exhibitor
Penstock Group
Website: https://www.penstockgroup.com/
Penstock is a service partner and SaaS builder for forward-thinking health plans and providers, empowering recovery, audit and regulatory teams to get accuracy right from the start—when it matters most. Our mission is to create lasting systemic change that removes wasted spend from our healthcare system, returning dollars to payers, lowering the cost of care and improving access for all.
Penstock is powered by industry veterans who are some of the most sought-after payment integrity and regulatory experts in the industry. Our business model is rooted in transparency and the drive to reinstate true integrity in payment integrity—even if it defies traditional business sense.
Our audit workflow SaaS platform, ClearBridge gives health plans the tools and insights they need to identify overpayments, correct them and implement their own edits with ease, ensuring correct payments and mitigating future discrepancies.
When you partner with Penstock, you reclaim time and control with an end-to-end partnership that beautifully and seamlessly connects human and machine intelligence—to prevent recurring issues at the source.
PARTNER WITH US
Based on your objectives, we can create bespoke packages designed specifically for you – from presenting your expertise on the main stage, to hosting a private dinner. You can partner with us showcase your brand and make valuable new connections. Opportunities predominantly lie in 3 main categories: Thought Leadership, Branding & Networking.
To discuss your objectives and partnership opportunities please contact Harry Ludbrook, Sales Director [email protected]
Interested in a media partnership?
We'd love to hear from you and how we can support one another to connect with the industry. Contact Jodie Purser, Marketing Manager, [email protected]
PARTNER WITH US
Based on your objectives, we can create bespoke packages designed specifically for you. Opportunities predominantly lie in 3 main categories: Thought Leadership, Branding, and Networking.
Interested in a media partnership?
We'd love to hear from you and how we can support one another to connect with the industry. Contact [email protected]
Delivering scalable and flexible solutions which ensure accuracy and integrity of claims
Join us at the 7th Annual Healthcare Payment & Revenue Integrity Congress returning in Nashville!
Whether you’re looking for vendors with proven ROI or insourcing strategies from health plan leaders, this event has it all. Explore AI-driven solutions for improving data analytics, reducing FWA, and enhancing claims accuracy. Network with peers and collaborate with providers to drive efficiency and financial success for your plan!
Venue
MILLENNIUM MAXWELL HOUSE HOTEL 2025 Rosa L Parks Blvd, Nashville, TN 37228
We're excited to welcome you face-to-face in Nashville at Millenium Maxwell House Hotel for the Healthcare Payment & Revenue Integrity Summit!
If you're looking for accomodation, you can book at a discount here.
About Kisaco Research
Kisaco Research produces, designs and hosts B2B industry conferences, exhibitions and communities – focused on a specialized selection of topic areas.
Meet industry peers that will help build a career-changing network for life.
Learn from the mistakes of your peers as much as their successes—ambitious industry stalwarts who are happy to share not just what has made them successful so far but also their plans for future proofing their companies.
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