Overview of Consulting Solution for Health Plans

Overview of
Payment Integrity Consulting

TogetherMD offers a robust Payment Integrity solution aimed at uncovering hidden medical and administrative cost savings for inpatient DRGs, short stays, and readmissions. Leveraging GapAI™ with advanced NLP and machine learning algorithms, we prioritize high-value claims for detailed review. Our experts meticulously examine these claims, both pre- and post-payment, to detect overpayments and ensure clinical quality, driving substantial returns for health plans.

With the TogetherMD Guarantee, you only pay if we succeed.

Key workflow actions
  • Prioritize: GapAI™ assigns scores to all claims, focusing our experts validation efforts on high-value patient accounts.
  • Assess: TMD auditors and GapAI™ scrutinize every chart, identifying opportunities for clinical validation and cost savings.

  • Perform: TMD CDIs provide intuitive “agree” and “disagree” workflows for simplified and productive workflows, yielding 6:1 returns.

Primary Results for Health Plans

Key Results of
Payment Integrity Consulting

At TogetherMD, our experts analyze patient claims to improve DRG, short stay, and readmission accuracy, boosting revenue potential. With our focus on exceptional payment integrity outcomes, health plans often see results weeks ahead of competitors.

400%

Improved
Productivity

34%

Change
Rate

$190 K

Revenue Capture per
1,000 Discharges
Key Benefits for Health Plans

Key Benefits of
Payment Integrity Consulting

TogetherMD’s GapAI™ technology, alongside our expert consultants, streamlines case selection for excellent returns.

Reduced
Expenses

Comprehensive review saves about $190,000 per 1,000 discharges for DRG, short stays, and readmits

AI-Driven
Account Prioritization

AI-driven high-value case identification and prioritization enhance medical spend capture and expedite cash flow

Guaranteed
Impact

Engage us on a contingency basis; if we don’t find opportunity, clients pay nothing

Improved
Productivity

Experience significant productivity gains with TMD experts as an extension of your team

Quick
One-Time Setup

Our team onboards a client in hours and not days, including data interoperability and process alignment

Minimal
Time Commitment

Our intuitive “agree” and “disagree” workflows require minimal client time

AI Technology for Health Plans

Built-in Intelligence for
Payment Integrity Consulting

Leveraging GapAI™ technology, we employ continuously evolving algorithms driven by ongoing client reviews and regulatory updates. This approach enables the identification of high-value coding and clinical validation errors, thereby safeguarding against overpaid inpatient DRG, short stays, and readmissions to hospitals.