Headline Partner
AMS Intelligent Analytics
Website: www.amspredict.com
Advanced Medical Strategies (AMS) is the premier provider of payment integrity, risk management, and business intelligence solutions to identify and address excessive claims, prevent and recoup overpayments, and effectively manage the risks associated with high-cost claimants and group health underwriting.
Find out more: https://pricetransparency.com/
Platinum Partner
Alaffia Health
Website: www.alaffiahealth.com
Alaffia is a new kind of health plan operations partner. We use expert clinicians and transparent AI to elevate your end-to-end claims operations with deeper insights, smarter automation, and consistently better outcomes across the entire claims lifecycle. Our solutions support Utilization Management, Payment Integrity, and Appeals—giving your teams the clinical context and operational intelligence they need to work faster and drive consistently better outcomes.
Healthcare Fraud Shield
Website: www.hcfraudshield.com
Healthcare Fraud Shield (HCFS) is a leading provider of fraud, waste, abuse, and error (FWAE) detection and payment integrity solutions for healthcare payers nationwide. Our platform stops improper claims before payment and detects issues after payment using advanced analytics, AI, and shared intelligence from a broad client network. With over 14 years of exclusive focus on FWAE and payment integrity, HCFS was built by industry experts to deliver measurable results. Clients typically achieve an average up to 10:1, and higher when leveraging HCFS Services.
Why HCFS:
- Enterprise-wide SaaS solution – Used by health plan teams across SIU/FWA, Payment Integrity, Risk, UM, Claims, Legal, Operations, and Finance
- 2,100+ FWAE rules – The largest FWAE rule library in the industry
- AI + Human-in-the-Loop – 11 AI models (FWA360Leads, AIShield, RecordPlus), all expert-validated
- Shared Analytics – Insights from 95M+ members across plans to uncover new, high-value cases beyond internal data
- 85+ external data sources – Enrich claims data for more precise detection
- Trusted by 70+ clients, including 7 of the 10 top commercial payers and 3 of the 5 of the top national payers
Gold Partners
Shift Technology
Website: www.shift-technology.com
Shift Technology empowers health plans to strengthen payment integrity with precision, fairness and speed at critical steps of the claim lifecycle. With a continually optimized concept library, enriched data, and advanced, healthcare-trained AI, Shift detects and helps plans prevent errors and improper payments to maximize savings. Our SaaS-based solutions drive accelerated and insightful decision-making, helping health plans reduce costs and enhance operational efficiency.
Silver Partners
Lyric
Website: www.lyric.ai
Lyric is the payment integrity Al company trusted by the nation's leading health plans at the beginning of the claims payment workflow. The Lyric platform is built on Al from the ground up and trained on 35 years of clinical expertise with real time integrations across 190 million lives. Lyric reduces wasted healthcare spending and ensures fast, accurate payments that drive transparency between payers and providers. Lyric is recognized as the 2025 Best in KLAS for Pre-payment Accuracy and Integrity.
Optum
Website: business.optum.com/en/operations-technology/payment-integrity.html
Optum is a leading information and technology-enabled health services business dedicated to helping health plans achieve payment accuracy and improve cost savings across the claim lifecycle.
Community Partner
Nokomis
Website: nokomishealth.com
Nokomis Health is a privately‑owned, Minneapolis‑based leader in Pre-payment Payment Integrity.
Founded in 2013, they leverage their proprietary ClaimWise™ platform alongside over 650 years of combined industry expertise to review every professional and facility claim—before payment—with next‑business‑day turnaround
They deliver an average of 9% incremental savings, uncovering coding errors, upcoding, and fraud that others miss—all at no upfront cost.
With a <2% appeal rate and <0.5% overturn rate, Nokomis ensures minimal provider friction
Their contingency‑based model aligns incentives and frees up critical funds for member programs and quality initiatives.
Exhibitors
4L Data Intelligence
Website: 4ldata.com
4L Data Intelligence™ is leading the way in a new era of healthcare program and payment integrity using the patented power of Integr8 AI Risk Detection™ technology to find, fight and prevent FWA in near real-time. Integr8 AI™, coupled with our continuously credentialed provider database, creates a revolutionary provider-centric capability to dynamically detect FWA you cannot see with stacks of traditional claims data-centric editing and analytics solutions.
The 4L FWA Prevention™ solution rapidly detects and prevents FWA at five points across the claims management workflow including pre pre-payment, pre-payment and post-payment positions. At each point, patented Integr8 AI technology dynamically and continuously detects provider behaviors, relationships and outliers without the limitations of rules-based and claim data-centric solutions. In short, it enables you to see what providers are doing individually, in relationship with all other providers, and in relationship to all other claims on each-and-every claim submitted.
4L FWA Prevention pre-payment and post-payment detection and prevention results are continuously delivered in four complementary modules. These are:
- Provider Integrity Edits
- Adaptive Claims Edits
- Billing Behaviors Analysis
- Provider Schemes Analysis.
For SIU teams, the new 4L SIU Hub™ packages the expanded range of Integr8 AI powered FWA detection behaviors and schemes into easy to use views with comprehensive investigation and lead management tools. This new capability increases FWA detection, reduces complexity and increases speed-to-decision on lead triage and investigation. All so you can Find, Fight and Prevent FWA Fast™.
Avelis Health
Website: www.avelishealth.com
Avelis Health deploys machine learning models to identify and recover overpayments on medical claims. Our AI call center does automated outreach to providers to handle the entire post-payment recovery and dispute process. We work with TPAs, health plans, and payment integrity vendors.
CAQH
Website: www.caqh.org
CAQH is the trusted data connector at the core of healthcare. For more than 25 years, the organization has powered the industry with the largest and most complete healthcare data foundation in the U.S., with more than 4.8 million provider data records sourced directly from providers and member data supplied by all national health plans. By improving how essential information flows across the system, CAQH helps healthcare operate more efficiently and with greater confidence. Learn more at CAQH.org.
CERIS
Website: www.ceris.com
CERIS has 30 years of prepay and post pay claim review and repricing experience with a 97% client retention rate. Our solutions are deep, consistent, and defensible reviews, which make CERIS the partner of choice for health plans, Medicare and Medicaid plans, and third-party administrators. CERIS’ longstanding review services and clinical expertise offer incremental value and are grounded in a sincere dedication to our valued partners. CERIS' mission is to continue to grow and deliver long term Payment Integrity services for our partners and to help them save.
Machinify
Website: www.machinify.com
Machinify is redefining payment integrity with AI-powered solutions designed to be frictionless, intelligent, and future-ready. Trusted by over 60 health plans, Machinify simplifies the complexity of healthcare claims with a platform that coordinates, validates, and pays claims with precision. Backed by cutting-edge technology and healthcare expertise, Machinify delivers cost savings, operational clarity, and strategic insight—empowering payers to take full control of their payment operations.
Machinify Solutions
Machinify offers a unified platform for payment integrity, combining pre-pay and post-pay solutions to detect, prevent, and resolve improper payments across the claim lifecycle.
- Pre-Pay Adjudication & Accuracy: Automatically identify potential errors or duplications before claims are paid, reducing downstream recovery efforts.
- Post-Pay Analytics & Recovery: Leverage advanced AI to uncover patterns, prioritize audits, and streamline recovery with high accuracy and minimal friction.
- Audit & SIU Support: Equip Special Investigation Units and audit teams with AI-enhanced tools to detect fraud, waste, and abuse faster and more effectively.
- Configurable, Modular Platform: Tailored to integrate into existing workflows with flexibility and speed, enabling rapid value without disruption.
Machinify’s intelligent platform unifies fragmented payment integrity processes, empowering payers to reduce costs, increase efficiency, and improve payment accuracy at scale.
MedReview
Website: www.medreview.us
MedReview sets itself apart with over 50 years of experience delivering physician-approved pre-pay and post-pay payment integrity services that prioritize billing and payment quality, accuracy, and precision. Every claim reassigned by MedReview is reviewed, approved, and documented by a team of physicians, resulting in the industry’s lowest appeal overturn rate.
Utilizing proprietary technology combined with extensive subject matter clinical and administrative expertise, we achieve a 40% or greater reassignment rate focused on our clients’ specific needs. MedReview provides the full spectrum of payment integrity solutions including DRG and clinical reviews, cost outlier audits, re-admission reviews, data mining and itemized bill reviews.
Partnered with clients across the country, MedReview offers a flexible approach, supporting both complete outsourcing and supplemental enhancements to existing programs. By optimizing recoveries, preventing overpayments, and improving the provider experience, MedReview empowers payors to navigate the complexities of payment integrity with confidence and measurable success.
Nēdl Labs
Website: nedllabs.com
Nedl Labs is an AI-native healthcare intelligence company pioneering a "Transparent Glass Box" approach using Neuro-Symbolic AI to ensure Payment Integrity. Founded by veteran tech and business leaders from Microsoft, Nokia, and Cognizant, the company is rebuilding trust in U.S. healthcare by replacing opaque "black box" algorithms with fully explainable, audit-ready AI.
The company’s flagship platform, nēdl Pulse, leverages advanced AI + reasoning to automate complex clinical and administrative decision-making. The platform integrates powerful modules, including Claims Repricer, Policy Intelligence, Contract Library, and DRG Review, to ingest unstructured data such as clinical notes and contracts and convert it into executable rules. This comprehensive suite drives deep Payment Leakage Analysis, allowing payers to identify and rectify discrepancies with precision.
By shifting the industry focus from post-payment recovery to pre-payment prevention, Nedl Labs empowers Regional Blues, Medicare Advantage, and Medicaid MCOs to stop financial leakage before it occurs. This approach ensures financial accuracy and significantly reduces provider abrasion by providing clear, evidence-based rationales for every claim decision.
Penstock
Website: www.penstockgroup.com
Penstock is a high-performance payment integrity partner built for health plans that demand more—from their partners and their results. We work with national and regional health plans to restore the depth, attention, and transparency that has been lost in today’s increasingly consolidated payment integrity landscape.
Our human-led, auditor-controlled model combines deep payment integrity expertise with advanced data mining to uncover what others overlook. Every finding is grounded in plan-specific policy, contract language, and defensible logic—designed to hold up under audit, appeal, and regulatory review. The result is real dollars recovered, recurring issues addressed at the source, and sustained improvements in payment accuracy.
Penstock’s post-pay work functions as a plan’s research-and-development engine for pre-pay. Through deep post-pay audits and ongoing data mining, our teams generate 4–6 new claim overpayment concepts each month. By analyzing claims with full context and clinical nuance, we identify not just individual claim overpayments, but the systemic patterns behind them—providing the insights plans need to strengthen pre-pay controls and prevent future leakage.
As payment integrity vendors consolidate and innovation stalls, health plans turn to Penstock for precision, accountability, and results that compound over time. Ranked No. 353 on the 2025 Inc. 5000 list—top 50 in healthcare—and named the fastest-growing private company in the Northeast, Penstock is redefining what defensible, modern payment integrity should look like.
Wolters Kluwer
Website: www.wolterskluwer.com
MediRegs, a Wolters Kluwer solution, designed to significantly boost your organization's return on investment. Gain precise insights into regulatory, reimbursement, coding, and compliance matters, ensuring a cohesive strategy for success. Safeguard your bottom line and empower your staff to leverage automation and analytics for improved efficiencies and enhanced cash collections.
