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AS MEDICAL SPEND CONTINUES TO INCREASE, EMPLOYERS ARE LOOKING TO MITIGATE THESE COSTS THROUGH MORE EXPANSIVE CLAIM REVIEWS THAT DETECT WASTE IN THE HEALTH CARE SYSTEM. Complexities in health care regulatory policies and coding practices, rapidly evolving technologies, and interest in streamlining reimbursement all drive the need for a comprehensive approach to payment integrity.Advanced Payment Review helps ensure self-funded employers proactively mitigate wasteful spend %u2014 without reducing quality of care for members %u2014 through our holistic payment integrity enhancement. APR%u2019s multifaceted claims review process blends advanced technology with skilled human capital to better identify anomalous coding and billing trends and create sustained improvements to provider behavior at a lower fee than competitors. This sophisticated approach proactively addresses evolving client and market needs to continually reduce ASO employer spend and significantly enhances claim reviews and reporting beyond the foundational capabilities to maximize client savings realization in a transparent and meaningful way.APR is a compilation of specialized reviews that target billing errors based on a diverse range of claim categories. Our end-to-end payment integrity reviews take a multi-layered and comprehensive approach to reducing medical spend, including:%u2022 Advanced Claim Editing: Vendor-performed automated claim editing and coding validation adhering to AMA, CMS, plan policies/procedures and coding standards performed both prospectively and retrospectively%u2022 Complex Clinical Claim Reviews: Prospective and retrospective forensic high-dollar and DRG claim reviews and audits by experts using patient medical records%u2022 Data Mining and Advanced Analytics: Enriched data mining using customized algorithms that review historical claims to further identify and recover overpayments %u2022 Out-of-Network Claims Management: Rate negotiation and pricing services for out-of-network, out-of-state claims%u2022 Subrogation: Ensure claim payouts by another liable party occur seamlesslyAdvanced Payment Review APR%u2019S 2024 BOOK-OF-BUSINESS AVERAGE SAVINGS$8.8%u2013$22.34 PEPM(on allowed and paid dollars)** Note that employer savings can drastically vary due to various factors such as an employer%u2019s particular demographics