Healthcare Payment Integrity Services
Protecting payment accuracy across the entire claims lifecycle.
The High Costs of Inaccurate Payments
Health plans face rising claim complexity, making it harder to ensure payment accuracy both before and after claims are paid. Manual processes and fragmented data allow improper payments to slip through while increasing downstream recovery effort and provider friction. Payers need a scalable, tech-led framework that supports prevention, detection, and recovery across the full claims lifecycle.
Real Results. Real Impact.
$1.
in-pre-pay savings
validations handled
$
in annual recoveries in post-pay
increase in clinical hit rate achieved through automation
reduction in disputes
Sagility’s Payment Integrity Suite
Sagility’s Payment Integrity suite helps health plans prevent, detect, and recover inaccurate payments across the claim lifecycle. Our analytics-driven approach is powered by the expertise of our clinical reviewers, coding specialists, and operational teams, bringing the human judgment needed to turn insights into action. The result: measurable impact and stronger provider trust.
Pre-Pay Claims Review Services
Sagility prevents improper payments before claims are paid using analytics-driven targeting, configurable pre-pay concepts, and expert clinical and coding review.
Key Capabilities
- Analytics-driven identification of high-risk, high-value claims prior to payment
- Targeted clinical, coding, and contract validation before adjudication
- Configurable pre-pay concepts designed to prevent improper payments and reduce downstream rework
Post-Pay Claims Review Services
Sagility identifies inaccurate post-pay claims using analytics, clinical review and automation to capture missed savings with less provider abrasion.
Key Capabilities
- Identification of inaccurate or non-compliant claims after payment
- Clinical, coding, and contract review to support defensible audit findings
- Analytics-driven targeting to prioritize audits with the highest recovery potential
Clinical Audit Services
Sagility applies deep clinical expertise and policy-driven review to evaluate medical necessity, appropriateness of care, and clinical compliance for complex, high-risk claims.
Key Capabilities
- Medical necessity and policy compliance review for complex claims
- Diagnosis-related group (DRG), short-stay, and specialty-specific clinical validation
- Deep clinical analysis to support accurate reimbursement and regulatory compliance
Coding Audit Services
Sagility validates coding accuracy and documentation integrity using certified coding expertise and technology-enabled workflows to support compliant reimbursement and reduce financial risk.
Key Capabilities
- Validation of coding accuracy across DRG, ambulatory payment classification (APC), and evaluation and management (E/M) claims
- Documentation review to ensure codes are fully supported and compliant
- Technology-led workflows to improve audit efficiency and consistency
Overpayment Recovery Services
Sagility manages the full recovery process with automated tracking and provider-friendly outreach to reclaim validated overpayments quickly and transparently.
Key Capabilities
- End-to-end recovery management for validated overpayments
- Provider outreach, documentation, and appeals support
- Automated tracking and reporting to improve recovery timelines and transparency
Decades of Partnership, Performance, and Progress.
Clients stay with Sagility for a reason: deep-domain expertise, measurable outcomes, and a true partnership approach. Purpose-built for healthcare and trusted by the nation’s top health plans and providers, we bring decades of experience and a proven ability to simplify operations and deliver lasting impact.
Straight from the Source
We’re more than a vendor, we’re a partner. Here’s what our clients have to say:
I love working with the Sagility team. They are professional, caring, and always willing to help wherever needed. They deliver high-quality work promptly and consistently exceed expectations.
Senior Payment Integrity Professional,
National Health Plan
They have done an outstanding job serving as our primary point of contact and consistently delivering beyond expectations. They champion our requests and help hold the right stakeholders accountable — including themselves. Sagility is a partner we can rely on for timely execution and transparency. The team is highly capable and consistently meets our requirements.
Director, Partner Operations,
Leading Provider Organization
Sagility consistently meets quality targets and maintains excellent service standards. The team is extremely flexible and ready to assist whenever needed.
Supervisor,
Regional Health Plan
Case Studies
See how we’ve helped payers unlock millions in savings and streamline operations:
Insights & Resources
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