Payment Integrity, By Design.

Serving Regional Health Plans, ACOs, MCOs, and TPAs

The Challenge.
Payment integrity (PI) models that don’t fit your structure.

Most PI services are built for high-volume, national payers. They require you to change your own structure and workflows.

This lack of alignment leads to missed savings, administrative burdens, diminished service levels, slower speed to value, and strained provider relationships.

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A payment integrity solution designed for your unique blueprint.

Every engagement is built around your cost management and provider strategy. This ensures you get fast results aligned to your strategy without the friction of complex system integrations.

Our independent approach aligns our incentives directly with your specific financial goals.

Solutions tailored to your financial blueprint.

Data Mining and Recovery

Clinical DRG Audit

PI Governance and Customization

Coding Validation

Coordination of Benefits (COB)

Configuration and Editing Review

Prior Authorization to Claim Alignment

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Expertise from leadership on both payer and vendor sides.

Buildr Health was founded with deep payer-side and PI and UM vendor-side experience so we know exactly where financial gaps occur and how to stop them.

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Frequently Asked Questions.

What makes Buildr Health different from national vendors?

We were built specifically for regional health plans, ACOs, MCOs, and TPAs. National vendors usually focus on large, high-volume clients and expect you to fit into their rigid systems. We do things differently. We design every solution around your unique blueprint and existing workflows so you never have to change your structure just to make a vendor work.

How quickly can we expect to see financial results?

We identify meaningful financial impact within 90 days. Implementation is fast and simple with no complex integrations. This lets you start recovering overpayments and protecting your margins quickly while staying in full control of your operations and provider relationships.

Do I need to change my systems to work with you?

No. We work directly within your existing data architecture and operational workflows. This means no major disruption and no forced platform changes, so your team can stay focused on serving your members and running your organization effectively.