Diagnosis-Related Group Business Solutions Lead

Abacus Insights has launched its Payment Integrity Suite, comprising three modular solutions designed to help health plans modernise payment integrity through unified data management. The suite addresses challenges faced by health plans, which typically use between two to seven vendors and rely on disconnected data silos across claims, member, provider, contract, and vendor information. The suite includes a Payment Integrity Data Foundation that unifies PI data across internal programmes and external vendors, the CoverSelf Platform for configurable pre-pay and post-pay claim editing, and an AI-enabled complex claim audit solution that helps reviewers identify payment errors more efficiently. "Payment integrity is about far more than recovering improper payments after they occur," said Minal Patel, founder and CEO of Abacus Insights. The platform serves 35 customers covering 65 million lives.

Abacus Insights launches Payment Integrity Suite built on trusted data. A unified data foundation helps health plans improve payment integrity and prepare for AI innovation BOSTON-(BUSINESS WIRE)-Abacus Insights today announced the launch of its Payment Integrity Suite, three modular solutions that help health plans modernize payment integrity (PI) through trusted data, payer-controlled visibility, and AI-enabled innovation. For most health plans, PI processes are complex and labor intensive. Health plans use between two to seven vendors for their PI programs and rely on disjointed data siloes across claims, member, provider, contract, and vendor data. This set up is time-consuming, labor intensive, and makes it difficult to measure performance, much less to improve payment accuracy. The Abacus Payment Integrity Suite addresses these challenges by helping plans build a unified PI data foundation. Without disrupting existing vendor relationships, this solution lets plans own, see and work with all their data. Additional solution modules include transparent claims editing and AI-powered complex claims auditing. "Payment integrity is about far more than recovering improper payments after they occur," said Minal Patel, MD/MPH, Founder and CEO of Abacus Insights. "Health plans need full visibility across the entire PI lifecycle so they can identify issues earlier, improve program performance, and confidently move forward with AI. "When it comes to AI, payers can have confidence with our data solution," added Patel. "It is governed, trustworthy, and relies on human-in-the-loop supervision, so you can believe in and verify the results." The Abacus Payment Integrity Suite includes: The Payment Integrity Data Foundation Finally, a single source of truth for PI. This data foundation helps health plans unify PI data across internal programs, external vendors, and operational workflows. As a result, PI leaders can see and measure how their programs and vendors are performing. They also gain a trusted data foundation for analytics, automation, and AI initiatives. Payment Policies and Claim Editing on the CoverSelf Platform CoverSelf is a unified payment integrity platform that brings payment policies, clinical policies, and claim edits together in one place. Any policy or edit can be configured to run pre-pay, post-pay, or both. Within the Abacus Payment Integrity Suite, the CoverSelf platform delivers self-service pre-pay and post-pay PI capabilities, built on its built-in Concept Library, one of the industry's most extensive libraries of continuously updated, clinically validated content. AI-Enabled Complex Claim Audit The complex claim audit solution combines AI-powered capabilities with trusted PI data to help reviewers identify, investigate, and resolve complex claim payment errors more efficiently. By accelerating research and surfacing supporting information, the solution makes reviewers more productive while allowing humans to make final determinations. Together, the three modular solutions help health plans improve payment accuracy, streamline operations, reduce administrative burden, and establish a scalable framework for future innovation. "Our vision is to provide plans with a PI platform that grows alongside their needs," Patel added. "Whether an organization is focused on improving program visibility, increasing payment accuracy, expanding operational control, or exploring new AI-enabled opportunities, the Payment Integrity Suite provides a foundation they can build on over time." About Abacus Insights At Abacus Insights, Business Wire, Inc. believe the right information, in the right hands, at the right time, improves health. And that for too long, health payer data has been disconnected and unusable. As data is now health plans' most strategic asset, Abacus Insights' AI data platform for payer intelligence quickly transforms their messy, disconnected data into a reliable, AI-ready infrastructure. A data infrastructure that powers business-critical analytics, agents, and real-world workflows. Building this infrastructure in-house takes long implementation cycles and highly skilled teams. Its clients skip that work, instead getting a proven platform, 150+ pre-built connectors, and deep payer expertise, backed by 35 customers and 65 million covered lives. Working with Abacus lets payers transform their business and power better health.