Advanced Medical Pricing Solutions (AMPS), a leader in healthcare cost containment and payment integrity solutions, announced the launch of ClaimInsight, a cutting-edge payment integrity platform engineered to deliver unmatched accuracy, cost savings, and seamless integration for payers and TPAs.
ClaimInsight is not just another payment integrity tool, it’s a transformative payment integrity platform designed to solve the most frustrating challenges plaguing payers and third-party administrators (TPAs): waste and abuse in medical spend, lack of transparency, costly contingency models, outdated technology, and inadequate high-dollar claim reviews. By combining a robust rules engine, a comprehensive medical policy library, and physician led expertise, ClaimInsight ensures every dollar is accounted for and every decision is defensible.
“This isn’t just an upgrade, it’s a game-changer,” said Jonathan Jeffress, Chief Operating Officer at AMPS. “ClaimInsight brings modernized, transparent claim editing together with physician led high-dollar claim review, all at the industry’s best value. It’s about delivering maximum savings, edit and review transparency, a client-centric approach; resulting in complete confidence with every claim decision.”
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Why ClaimInsight Stands Apart
With a best-in-class content library powered by IPU, a highly configurable platform that integrates effortlessly into your workflows, and physician led itemized bill review, ClaimInsight is built to deliver rapid, impactful results. ClaimInsight offers pricing models (including PMPM) that are customer-focused and maximizes ROI. Our clients experience savings of $5,000,000 per 100,000 members annually.
Introducing Intelligent Policy Update (IPU) and High Dollar Review (HDR)
As part of the ClaimInsight suite, AMPS is introducing two innovative tools:
Intelligent Policy Update (IPU): Ensures payers always have the most up-to-date medical policies, reducing errors and improving accuracy.
ClaimInsight HDR (High-Dollar Review): A targeted solution for high-dollar claims, which often represent the greatest financial risk. Key features include:
- Physician Led Expertise: Team of licensed physicians conducts detailed, line-by-line reviews to identify errors, overcharges, and unnecessary services that algorithms miss.
- Customizable Thresholds: Set review thresholds as low as $25,000 to align with your organization’s unique needs.
- Maximum Savings: Every claim is scrutinized to ensure no opportunity for savings is overlooked.
Why Payers Choose ClaimInsight
ClaimInsight is where payment integrity meets real results. It’s a next-generation platform that redefines accuracy, efficiency, and value. Payers choose ClaimInsight because it saves them more, costs them less, and works faster than any other solution available today.
It delivers hard-dollar savings by preventing overpayments and unnecessary services, like the $8.5M saved for a 160K-life Medicaid plan. This isn’t just payment integrity—its payment integrity redefined.
AMPS continues to lead the way in healthcare cost containment by delivering best-in-class solutions that optimize claim accuracy and financial outcomes for health plans, self-funded employers, and third-party administrators.
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