Our approach

Payment integrity ensures that a health claim is paid correctly—by the responsible party, for eligible members, according to contractual terms, not in error, and free of wasteful or abusive practices. But managing and improving payment integrity is not as simple as defining it.

Discovery Health Partners is dedicated to helping health plans identify and remedy the many challenges they encounter in their payment integrity efforts. While these problems are often complex, the solutions don’t have to be. The Discovery  team has proven results in helping plans:

  • Simplify the approach to make improved payment integrity a manageable, achievable goal
  • Implement flexible solutions, either from our suite of proven solutions or by customizing our technology and expertise to meet a plan’s unique needs
  • Recognize better payment integrity results quickly and with minimal disruption

Our team

Our people are essential to the superior delivery of our suite of solutions. That’s why every client is assigned an experienced Account Manager to ensure the highest levels of customer service and partnership. Here’s what you can expect from your Account Manager.

  • Proactive. We don’t wait for customers to call us with a problem.  We monitor results and reach out to customers proactively.
  • Experienced. Our account managers are more than customer service reps—they bring operational experience to the table. We understand your business because we’ve walked in your shoes.
  • Partnership. No matter what your challenge is, we’re there to help you solve it. Clients say they view us as an extension of their team and a trusted partner.
  • Results. We will measure the impact of your results and look for ways to improve. Together we’ll maintain our track record of 100% client satisfaction.

Our benefits

Quality implementation program keeps an eye on consistency, timeliness, and cost.

An experienced team

First, we hold a kickoff meeting to explain the implementation process, introduce next steps, and outline resource requirements. We assemble a powerful team consisting of a Project Manager, Data Integration Expert, and Account Manager, who is your champion and primary point of contact throughout the relationship. This team works tirelessly with your business and IT experts to learn about your unique business and validate your data.

The right data

The most critical factor of a successful implementation is getting the data right. We’ll work closely with your IT resources to communicate information about data acquisition and exchange (frequency, format, transport technology, and security), data content (claims, eligibility, and provider), and reporting requirements. A data analysis process verifies that we understand how your claims work and confirms that payment integrity processes run smoothly from the start.

Business alignment

Our flexible technology platform was designed to accommodate client-specific business processes and reporting needs so our solutions work the way you want them to work. We will configure our systems to meet your unique business needs, from roles and access rules to work allocation, prioritization parameters, reporting, and more.

“Discovery builds strong relationships with clients to better understand our business needs. I have worked with many vendor partners in my managment role and Discovery has been the best partner.”

Learn more

How much are payment integrity challenges impacting your bottom line?

See how Discovery Health Partners leverages technology and expertise to effectively improve payment integrity outcomes.

Payment integrity success for payers

We’re trusted partners because we’re transparent about our processes, our work in progress, and our results. We learn your business and solve the tough challenges. Read on to see how we delivered payment integrity results for five health plans.

Overview: Your partner in healthcare payment integrity

Our consultative approach is the key to the impressive results we’ve helped more than 40 plans achieve. Read more about how we will work with your plan to do the same.

Rey VillarOur Approach