What You Should Know:
– New Mountain Capital has announced the formation of a new company that merges Rawlings, Apixio’s Payment Integrity business, and VARIS to form a next-generation payment accuracy and integrity platform.
– The combined entity aims to lower healthcare costs by leveraging technology and AI to improve payment accuracy and reduce waste.
– The combined entity brings together a wealth of experience and expertise in the healthcare industry. With over 1,900 technology, coding, legal, and clinical experts, the company is well-positioned to deliver results.
Addressing the Burden of Administrative Complexity
Administrative complexity is a major driver of excess spending in the US healthcare system. The new company’s comprehensive platform offers solutions to address this challenge, including:
- Subrogation: Recovering payments from third-party payers.
- Coordination of benefits: Ensuring accurate billing and payment when multiple insurance plans are involved.
- Pharmacy payment integrity: Verifying the accuracy of pharmacy claims.
- Complex claim solutions: Handling complex claims that require specialized expertise.
Leveraging AI and Technology
The new company’s AI-powered platform enables it to:
- Identify errors: Proactively detect errors in claims processing.
- Improve accuracy: Enhance payment accuracy and reduce overpayments.
- Lower costs: Generate significant savings for health plans.
David Pierre to Lead the New Company
David Pierre, former Chief Operating Officer of Signify Health, has been appointed CEO of the combined entity. Pierre brings a proven track record of success in the healthcare industry and will lead the company’s efforts to drive innovation and improve outcomes.
The Future of Healthcare Payments
The formation of this new company represents a significant step forward in addressing the challenges of healthcare payment integrity. By leveraging technology and AI, the company is poised to make a meaningful impact on the healthcare industry and improve the efficiency and effectiveness of payment processes.
