Payment Integrity

Trover’s Payment Integrity solutions ensure that accurate payments are made to the correct providers, finding savings for your business.  Our goal for Payment Integrity is simple: to find savings through the use of big data and best in class technology.

Our Solutions

Our cutting edge technology allows us to run deep, unlimited queries on all types of paid claims - including inpatient, outpatient, professional, pharmacy and ancillary – and to find any vulnerabilities in your current process.

Our suite of solutions includes traditional, standard solutions including:

  • Provider bill auditing services (hospital bill and DRG audits)
  • Coordination of benefits
  • Overpayments (paid after term, duplicate payments, retroactive payments)
  • Contract compliance

We also work with our clients to create custom data mining solutions including queries such as ambulance, emergency room and high cost drug.

Trover will examine your current claims payment landscape, and customize the right Payment Integrity solution to fit your needs.  And while each solution may require a slightly different set of skills and expertise, the same level of service and reporting is applied to each.

Data and Identification

Your data is more valuable to your business than you may realize.  Trover has the ability to analyze your complex data to make sure that it is working for you.

Trover will take your claims data and utilize multiple overpayment targeting methodologies, such as review of billing practices and coding rules, to quickly identify claims which have an opportunity for recovery. Significant investments have been made in the area of claims selection. This effort has led to an increase in identification of claims with savings. In addition to identifying traditional overpayment and audit savings, Trover uses your claims information to identify new queries for claims targeting and unique overpayment opportunities.  Our process for applying analytics to your data has been created to ensure that you are not losing profits and you are accurately paying your providers for their services.

Dual Validation

A strong validation process ensures that provider abrasion is minimized while opportunities are optimized.

A dual validation procedure is applied to each identified opportunity. First, opportunities are applied against a system of algorithms and re-pricing to confirm the recovery opportunity. Our second level validation, performed by industry experts, is what sets us apart of other data mining vendors. Trover has spent over 25 years building relationships in the healthcare industry, and has assembled a national network of industry experts including RNs, Certified Coders and URAC accredited panel.  These professional resources with broad and deep industry knowledge serve as an extension of your claims payment and analytics team, offering payment methodology expertise and provider intelligence.  Our team of experts will uncover and recover your overpayments, with detailed attention to member and provider sensitivity.

Collaborative Approach

Our collaborative approach, working with our clients as partners, ensures client satisfaction.

Trover takes clients' data and sees where there are weaknesses. We then work with our clients to research and develop a custom solution tailored to address those needs.   Our robust identification tools and data mining techniques are used to find opportunities while our dual validation process ensures we keep your provider relationships at the forefront of our solution.

Technology is the foundation of Trover’s business, and with constant and strategic investments, we continue to develop leading-edge innovations to make the most of your unique data.  We know that superior technology provides the power to pinpoint the best targets for recovery, and Troveris®, our proprietary software, stands above the industry standard.  Our advanced analytics provides sophisticated selection algorithms and is customized for maximum flexibility.