Cost Containment & Care Quality

Pre-payment Solutions

Gainwell's pre-payment solutions are comprehensive, compliant & configurable. See how we can help your organization minimize abrasion, alleviate administrative burden, and reduce claim spend.

Residency Verification - Eligibility Verifications

Our residency verification solution prevents future erroneous payments through the identification of non-residents. Learn how.

Pre-pay Clinical Claim Reviews for State Employee Health Plans Brief

Identify improper payments before a claim is paid, and avoid payment errors related to DRG coding and validation, readmissions, level of care, medical pharmacy and more.

Pre-payment Solutions - COB Data Management for Government Programs

Our COB Pre-payment Solutions offer comprehensive, CMS-certified and configurable features to advance your data management. Reduce administrative burden and proactively avoid cost.

Pre-payment Solutions - COB On-demand Technology for Government Programs

Gainwell's COB On-demand Technology allows you to move your cost avoidance upstream. Learn how this feature pairs with our CAV Match and Delivery offering to help your organization avoid cost.

Pre-payment Solutions - COB Self-service Portal for Government Programs

Our Self-service Portal allows clients 24/7 access to a user interface where they can submit ad-hoc verification requests, returning verified results to the user within 48 hours. Learn more.

Pre-payment Solutions - COB Performance Analytics for Government Programs

Our Performance Analytics feature equips clients with transparency into the health of their TPL data by delivering metrics & reports, ensuring data-driven actions are taken for continuous improvement.

Pre-payment Solutions - Cost Avoidance Match & Delivery for Government Programs

Our CAV Match & Delivery offering identifies members' existing other coverage, so healthcare organizations can proactively avoid cost, reduce administrative burden & alleviate provider abrasion.

Pre-payment Solutions - COB Call Center Support for Government Programs

Our call center representatives can verify COB information on the spot and provide near real-time results, ensuring providers can coordinate benefits effectively and members have access to care.

Pre-payment Solutions - COB Revalidation for Government Programs

Our COB Revalidation feature works seamlessly with a CAV deliverable to revalidate TPL segments every six months, ensuring a client's OHI files are as up-to-date as possible. Avoid cost proactively.

Care optimization meets cost reduction: A continuum-wide strategy for states and healthcare organizations

Pre-payment Solutions - Cost Avoidance Match & Delivery

Our CAV Match & Delivery offering identifies, verifies, and communicates members' existing other coverage so plans can proactively avoid cost, reduce administrative burden & reduce provider abrasion.

Pre-payment Solutions - COB On-demand Technology

The time period following enrollment is a high utilization period for new recipients. Our solution identifies other coverage at the point of enrollment to move cost avoidance upstream.

Pre-payment Solutions - COB Self-service Portal

Pre-payment Solutions - COB Call Center Support

Our call center representatives can verify COB information on the spot & provide near real-time results, ensuring providers can coordinate benefits effectively & that members have the care they need.

Pre-payment Solutions - COB Revalidation

Our COB Revaidation solution ensures the quality and accuracy of COB data even after delivery, eliminating stale COB information and reducing the risk of provider abrasion.