Our solutions help healthcare organizations optimize revenue, improve cost avoidance, and operate more efficiently

Healthcare is undergoing a dramatic restructuring driven by macro-level changes—the growing needs of an aging population, out-of-control healthcare costs, weakness in the U.S. economy, and major healthcare reform initiatives. Payers and providers are reassessing their strategies and operating models and driving significant change. Their top priorities focus on managing cost, eliminating waste and inefficiency, exploring new delivery models, improving the quality of care, and engaging the consumer in the healthcare process.

We offer a suite of payment integrity, information management, and analytics solutions for healthcare organizations:

  • Discovery Analytics solutions provide full transparency and insight into the performance of payment integrity programs.
  • Discovery Claims Analytics solutions help health plans optimize the claims process, ensure payment integrity, and manage costs.
  • Discovery Coordination of Benefits (COB) solutions help health plans identify more instances of other insurance coverage and optimize recoveries and cost avoidance.
  • Discovery Eligibility solutions help health plans manage eligibility data more strategically, with solutions that deliver a more efficient claims process, improved employer group reporting, and more accurate Medicare and Medicaid compliance and reporting.
  • Discovery Subrogation solutions leverage powerful technology and optimized processes to deliver improved recoveries for health payers.
  • Ajilitee Service Solutions help healthcare organizations optimize payment integrity by integrating expert healthcare industry knowledge with the right mix of data, technology, and business insight.
  • Ajilitee Cost Containment Checkup provides health plans with an objective and insightful assessment of claims recovery efforts across all areas of the organization. We measure and analyze all angles of performance to identify opportunities to minimize claims costs, maximize recoveries, and increase productivity of recovery teams.
  • Ajilitee Cost Containment Dashboard enables full transparency and insight into the performance of cost containment programs. Our dashboards, reports, and analytics provide health plans with powerful tools for evaluating performance, making more informed and objective decisions, and driving best practices.
  • Ajilitee Provider Cost and Quality Analytics create a single integrated resource for accurate and current provider data.  We can help payers evaluate and stratify providers based on cost and performance metrics, and increase utilization of cost-effective and high-quality providers.
  • Ajilitee Member Engagement solutions provide a powerful data foundation to support the transition from a business-to-business model to a business-to-consumer strategy with data integration and governance, marketing analytics, contact management, and advanced segmentation and targeting.