About Equian
Equian: Revolutionizing Healthcare Payment Integrity
Equian is a leading provider of payment integrity solutions for healthcare payers. The company was founded in 2003 with the mission to help healthcare payers reduce costs, improve efficiency, and enhance the overall quality of care. Equian has since grown into a global organization with over 2,500 employees across multiple locations in the United States, India, and Australia.
At Equian, we understand that healthcare payment integrity is critical to ensuring that patients receive the care they need while keeping costs under control. Our innovative solutions leverage advanced analytics and technology to identify improper payments and recover lost funds for our clients. We work with health plans, government agencies, third-party administrators (TPAs), self-insured employers, and other stakeholders across the healthcare industry.
Our Services
Equian offers a comprehensive suite of payment integrity services designed to meet the unique needs of each client. Our services include:
1) Claims Audit & Recovery: We use advanced analytics to identify improper payments made by payers or providers and recover those funds on behalf of our clients.
2) Coordination of Benefits (COB): We help payers avoid overpayments by identifying other insurance coverage that may be available for their members.
3) Subrogation: We assist payers in recovering funds from responsible third parties when their members are injured due to someone else's negligence.
4) Clinical Review: Our team of clinical experts reviews medical claims to ensure that they are medically necessary and appropriate based on established guidelines.
5) Data Analytics & Reporting: We provide actionable insights into payer data through customized reports and dashboards that enable informed decision-making.
Our Approach
At Equian, we believe in taking a collaborative approach with our clients. We work closely with them to understand their unique challenges and develop customized solutions tailored to their specific needs. Our team includes experienced professionals from diverse backgrounds such as healthcare administration, finance, law enforcement, data science, clinical practice management among others who bring deep expertise in various areas related to payment integrity.
We also invest heavily in technology innovation which enables us not only detect but prevent fraud before it happens using predictive modeling techniques powered by machine learning algorithms which have been trained on vast amounts of historical claims data from different sources including public records databases like CMS Medicare/Medicaid datasets as well as private sector sources like commercial insurance carriers' claims databases etc., making us one step ahead than traditional methods used by most TPAs or insurers today who rely solely on rules-based systems which can be easily circumvented by sophisticated fraudsters using new tactics every day.
Why Choose Equian?
There are several reasons why you should choose Equian as your partner for payment integrity:
1) Experience & Expertise - With over 18 years' experience serving clients across the healthcare industry globally , we have developed deep expertise in all aspects related to Payment Integrity including Fraud Waste Abuse prevention strategies , Claims Auditing & Recovery , Coordination Of Benefits (COB), Subrogation among others .
2) Innovative Technology - At Equian we invest heavily into developing cutting-edge technologies such as Predictive Modeling powered by Machine Learning algorithms trained on vast amounts historical claims data enabling us not only detect but prevent fraud before it happens giving you peace-of-mind knowing your plan is protected against emerging threats .
3) Customized Solutions - Every client has unique needs when it comes down managing Payment Integrity risks . At Equain we take time understand your business requirements then tailor-make solutions specifically designed around those requirements so you get maximum value out investment made towards protecting your plan against financial losses due fraudulent activities .
4) Collaborative Approach - At every stage engagement process whether its initial discovery phase where we learn more about what makes your business tick or implementation phase where actual solution deployed , our team works closely alongside yours ensure seamless integration between systems processes involved thereby minimizing disruption normal operations while maximizing benefits derived from working together towards common goal reducing waste abuse within system.
Conclusion
In conclusion,Equain is an innovative leader providing comprehensive Payment Integrity Solutions globally . With deep expertise gained over years serving diverse clientele ranging from Government Agencies Self-Insured Employers Third Party Administrators Health Plans among others coupled cutting-edge technologies like Predictive Modeling powered Machine Learning Algorithms trained vast amounts historical claims data enabling us not only detect but prevent fraud before it happens make us stand out amongst competition . So if you're looking protect your plan against financial losses due fraudulent activities while improving overall quality care delivered patients then look no further than partnering up with EQUAIN today!
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