Payment Integrity Solutions

Designed for your blueprint

We know how to drive payment integrity results.

We take the mystery out of payment integrity. Instead of pushing you into a one-size-fits-all system, we follow a simple three-step process built around your existing blueprint.

You stay in full control the whole time while we handle the rest.

Step 1: The Blueprint Audit

Your guide identifies financial leakage by analyzing your existing operations, provider strategy and current workflows.

Step 2: Precision Design

Your guide builds a custom strategy that protects your provider relationships and fits your specific reimbursement models.

Step 3: Expedited Execution

Your guide delivers measurable financial impact within three months without requiring complex integrations.

Custom Solutions

Data Mining and Recovery

Recover lost revenue by identifying overpayments within your existing data architecture.

Clinical DRG Audit

Validate readmissions and reduce inappropriate clinical spend through expert oversight.

PI Governance and Customization

Build a tailored payment integrity program that fits your specific operational DNA.

Coding Validation

Ensure proper reimbursement alignment through precise reviews of coding and assignments.

Coordination of Benefits (COB)

Manage COB to prevent duplicate payments and optimize recovery.

Configuration and Auditing Review

Examine and optimize configurations to minimize recurring errors.

Prior Authorization to Claim Alignment

Bridge the gap between clinical authorizations and claims for a unified strategy.

Why You Should Work with Us

Payment Integrity Differentiator/

Builder Health Differentiator Info-graphic

The Buildr Health difference designs payment integrity around your blueprint, aligning our incentives with your goals

Frequently Asked Questions.

Do you support multiple types of payers?

Yes. Our precision approach is designed for Regional Health Plans, ACOs, MCOs, and TPAs.

How quickly will I see a financial impact?

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 internal systems?

No. We work with your existing data architecture and operational workflows to ensure zero disruption.

How are you different from national vendors?

We design around your unique blue print instead of providing out of the box solutions and ensure you receive dedicated focus.

How do you handle provider relationships?

We maintain strong relationships by focusing on precision and alignment rather than high-volume tactics.