AI Payment Integrity for Payers

Prevent Overpayments and Revenue Leakage with HealOS

Payment integrity is a critical function for payers, ensuring claims are paid accurately, compliantly, and only for medically necessary services. Manual audits, post-pay reviews, and fragmented tools leave significant financial leakage unchecked. HealOS delivers AI-powered payment integrity built for payers. Our platform automates pre-pay and post-pay analysis, detects improper payments, enforces policy rules, and supports recovery at scale and with full auditability. This is modern payer payment integrity software designed to reduce cost and improve accuracy.

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Why Payment Integrity Is Broken for Payers Today

Payers face increasing payment complexity and leakage risk.

Limited visibility into improper payments

Manual, post-pay audits that miss issues

Inconsistent policy enforcement

High administrative cost per audit

Delayed identification of overpayments

Fragmented data across claims systems

Legacy approaches cannot scale with modern claim volumes. AI-driven payment integrity is now essential.

HealOS for Payer Payment Integrity

HealOS is an AI payment integrity solution for payers designed to automate detection, prevention, and recovery of improper payments. It connects claims data, policy logic, utilization patterns, and clinical context into one intelligent system, reducing leakage while improving operational efficiency.

~21 Days

Typical Go-Live Timeline

85%+ of Claims Analyzed Automatically

Payment Integrity Automation Coverage

100% Pilot Graduation

Deployment Conversion Rate

How HealOS Automates Payment Integrity for Payers

Step 1

Claim & Payment Data Ingestion

HealOS ingests claims, remittances, adjustments, and payment data from payer core systems, clearinghouses, and data warehouses.

Step 2

AI Risk & Pattern Detection

HealOS applies machine learning to identify overpayments, duplicate claims, upcoding, unbundling, and policy violations before or after payment.

Step 3

Policy & Contract Enforcement

HealOS validates payments against payer contracts, fee schedules, coverage policies, and utilization rules consistently across all claims.

Step 4

Pre-Pay & Post-Pay Controls

HealOS enables pre-pay edits to prevent improper payments and post-pay reviews to identify recovery opportunities.

Step 5

Recovery, Reporting & Audit Trails

HealOS supports recovery workflows, generates audit-ready documentation, and provides reporting for compliance, finance, and oversight teams.

Core Capabilities for Payment Integrity Payers

Pre-Payment Claim Validation

HealOS scans claims before payment using AI to detect coding errors, duplicate submissions, and out-of-policy billing, preventing improper payments before funds are released.

Automated Overpayment Recovery

HealOS identifies overpayments automatically, generates recovery notices, tracks recoupments, and manages recovery workflows to reduce financial leakage and manual follow-up.

Provider Pattern & Anomaly Detection

HealOS applies adaptive AI models to analyze historical payment data, identifying billing anomalies, outliers, and potential fraud across provider networks.

Automated Compliance & Audit Reporting

HealOS generates audit-ready payment integrity documentation automatically, supporting CMS, state regulators, and internal compliance teams with complete transparency.

Measurable Impact for Payer Operations

Track real improvements with AI-powered payment integrity.

40%

Reduction in Improper Payments

100%

Audit-ready transparency

90%

Reliability on the end-to-end workflow

Who HealOS Is Built For

Hospitals & Health Systems

Handle high inbound call volumes across departments and facilities.

Physician Groups

Reduce front-desk overload and missed appointment opportunities.

Behavioral Health Providers

Provide discreet, always-available call handling for sensitive patient needs.

Specialty Clinics

Manage complex scheduling and referral calls efficiently.

Telehealth Providers

Support virtual-first patient access with automated appointment scheduling.

Security & Compliance

HIPAA Compliant

Secure PHI handling without storage

SOC 2 Type II Certified

Independently audited enterprise security

Secure Authentication

SSO and multi-factor access controls

Frequently Asked Questions

Start Automating Payment Integrity for Payers

HealOS delivers AI-powered payment integrity for payers, reducing leakage, improving compliance, and scaling integrity operations.

Book a HealOS Demo