Pre-Pay Claims Review Services
Pre-pay review that improves payment accuracy before claims are paid.
Sagility combines tech-led pre-pay workflows and experienced payment integrity specialists to help health plans identify high-risk claims and prevent improper payments at the point of adjudication, working as an extension of your existing claims operations team.
Overview
As part of Sagility’s Payment Integrity Suite, our Pre-Pay Claims Review Services help health plans prevent improper payments before claims are paid. Delivered as an operational extension of health plan teams, analytics-driven targeting, configurable pre-pay concepts, and expert clinical and coding review validate claims against contract terms, clinical policies, and coding standards to support accurate, compliant payment outcomes. This prevention-first approach reduces downstream rework and recovery effort, lowers administrative cost, and helps minimize provider abrasion.
Pre-Payment Integrity
- Identify high-risk, high-value claims prior to payment
- Validate clinical, coding, and contract compliance before adjudication
- Apply analytics-driven targeting and configurable pre-pay concepts
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:
The team has been exceptional. They are responsive, have great communication skills, and have helped us streamline our claims processing workflow. Their AI-powered solutions have significantly reduced our manual workload and improved accuracy rates across the board.
VP of Operations,
U.S. Fortune 100 health insurance company
Their innovative approach to revenue cycle management transformed our operations. We saw a 40% reduction in claim denials and a 30% improvement in processing speed within just three months of implementation.
Chief Financial Officer,
Regional hospital network
The implementation was seamless, and their support team is outstanding. We’ve achieved 98% accuracy in claims processing and reduced our days in A/R from 45 to 28. Their technology is truly game-changing for healthcare providers.
Revenue Cycle Director,
Multi-specialty physician group
Case Studies
See how we’ve helped payers unlock millions in savings and streamline operations:
Insights & Resources
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