Prestigious International Annual Awards Program Honors Standout Digital Health and Medical Technology Products and Companies
IRVING, TEXAS — May 3, 2023 — Gainwell Technologies (Gainwell), a leading innovator of health and human services technology solutions, today announced that its Clinical Claim Reviews solution has been selected as winner of the “Best Healthcare InsurTech Solution” in the seventh annual MedTech Breakthrough Awards program. MedTech Breakthrough is an independent market intelligence organization that recognizes the top companies, technologies and products in the global health and medical technology market.
Gainwell’s Clinical Claim Reviews solution combines medical expertise and predictive analytics to improve payment accuracy, ensuring services documented on medical claims are accurately coded and billed.
“For years, states and healthcare organizations have struggled to address the challenges of claims errors. Our data-driven, automated approach reduces administrative burden for providers and accelerates overpayment recovery for payers,” said Mark Knickrehm, Chairman and CEO of Gainwell. “Our AI-driven Clinical Claim Reviews solution is an integral part of our clients’ payment integrity efforts, increasing innovation and helping states make the best use of healthcare dollars.”
Gainwell’s experienced clinical staff features more than 700 licensed professionals, including physicians, nurses, certified coders, dentists and behavioral health professionals to cover all claim types and specialties. These healthcare professionals partner with a dedicated team of data scientists who oversee the claim selection process. Their vast knowledge, combined with artificial intelligence (AI) and machine learning (ML) technology, creates battle-tested and constantly improving algorithms that target claims most likely to have errors. Gainwell provides Clinical Claim Reviews in both pre-pay and post-pay models.
To determine the likelihood of an inaccuracy that would impact claim payment, incoming data is analyzed combining proprietary ML technology with more than 10 petabytes of historical data — data based on Gainwell’s more than 15 years of experience reviewing medical records. Gainwell’s Clinical Claim Reviews solution features AI-driven Intelligent Review, which drives program value by increasing capacity for standard record reviews. With Intelligent Review, medical records are requested only when required for determination. Providers can review preliminary findings and submit records for claims they believe were billed accurately, without impacting appeal rights.
The mission of the MedTech Breakthrough Awards is to honor excellence and recognize the innovation, hard work and success in a range of health and medical technology categories, including Telehealth, Clinical Administration, Patient Engagement, Electronic Health Records (EHR), Virtual Care, Medical Devices, Medical Data and many more. This year’s program attracted more than 4,000 nominations from over 17 different countries throughout the world.
“As healthcare spending reaches unsustainable levels, state Medicaid agencies and Managed Care Organizations (MCOs) need new ways to contain costs while improving the efficiency of healthcare as a whole,” said James Johnson, managing director, MedTech Breakthrough. “Clinical Claim Reviews from Gainwell Technologies addresses this complex challenge, playing a valuable role in the new digital health ecosystem and using smart technology to contain costs and drive breakthrough innovation in the healthcare insurance payment process. Driven by synergy between AI and clinical experts, Clinical Claim Reviews improves payment accuracy — with minimal provider abrasion. Congratulations to the Gainwell team for taking home a well-deserved 2023 MedTech Breakthrough Award win!’”
About Gainwell Technologies
Gainwell Technologies is the leading provider of digital and cloud-enabled solutions vital to the administration and operations of health and human services programs. With more than 50 years of proven experience, Gainwell has a reputation for service excellence and unparalleled industry expertise. We offer clients scalable and flexible solutions for their most complex challenges. These capabilities make us a trusted partner for organizations seeking reliability, innovation and transformational outcomes. Learn more at gainwelltechnologies.com.
About MedTech Breakthrough
Part of Tech Breakthrough, a leading market intelligence and recognition platform for global technology innovation and leadership, the MedTech Breakthrough Awards program is devoted to honoring excellence and innovation in medical & health technology companies, products, services and people. The MedTech Breakthrough Awards provide a platform for public recognition around the achievements of breakthrough healthcare and medical companies and products in categories that include Patient Experience & Engagement, Health & Fitness, Medical Devices, Clinical Administration, Connected Healthcare, Medical Data, Healthcare Cybersecurity and more. For more information visit MedTechBreakthrough.com.