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Members

Control your biggest costs more efficiently than ever

SME-led, query-driven routines simply can’t keep up with today’s hyper-complex payment landscape – which is why we build technology that can. Our data-driven payment integrity solutions give health plans and claims managers the power to automate critical workflows and accelerate savings like never before.
Escape the status quo of expensive, hands-on payment accuracy reviews.
Harness the power of PREDICT to identify, evaluate, and mitigate inflated claims.
Slash outsourcing costs with automated workflows you can run in-house with ease.

Our most advanced payment integrity product, PredictPi is the single most powerful tool for auto-screening claims. With PredictPi, you can instantly identify and flag potential overpayments, easily validate courses of treatment, and proactively intercept your costliest claims – all in a fraction of the time it takes to conduct manual audits.

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Spot claim anomalies

Surface potentially excessive claims in seconds using best-in-class analytics.

Get root-cause transparency

Say goodbye to black box approaches with perpetual contingencies.

Maximize incremental savings

Zero in on your biggest cost drivers and surface new savings opportunities with our comprehensive clinical standards of care and financial benchmarks.

Reduce reliance on outside vendors

Still paying out for SMEs, data mining, and manual audits? FACS automates them away.
Spot claim anomalies
Spot claim anomalies

Surface potentially excessive claims in seconds using best-in-class analytics.

Surface potentially excessive claims in seconds using best-in-class analytics.

Get root-cause transparency
Get root-cause transparency
Say goodbye to black box approaches with perpetual contingencies.
Say goodbye to black box approaches with perpetual contingencies.
Maximize incremental savings
Maximize incremental savings
Zero in on your biggest cost drivers and surface new savings opportunities with our comprehensive clinical standards of care and financial benchmarks.
Zero in on your biggest cost drivers and surface new savings opportunities with our comprehensive clinical standards of care and financial benchmarks.
Reduce reliance on outside vendors
Reduce reliance on outside vendors

Still paying out for SMEs, data mining, and manual audits? PredictPi automates them away.

Still paying out for SMEs, data mining, and manual audits? PredictPi automates them away.

Unlock a new level of payment intelligence

Escape the expense of conventional payment integrity, and start auto-screening claims at enterprise scale. With just one tool, and one dynamic dashboard, you’ll get all the insights you need to minimize overpayments and maximize savings.

PredictPi Insights by Reason

Top 20 Members Flagged

Member ID

Group

Amount Allowed Flagged

Reason Flagged

Drug exceeds charge threshold

Drug exceeds charge threshold

$1,067,556

Drug exceeds charge threshold

Treatment charges

Treatment charges

$1,039,312

Orphan drug use

Treatment charges

Treatment charges

$1,032,045

Orphan drug use

Treatment charges

Treatment charges

$946,206

Drug exceeds charge threshold

Treatment charges

Treatment charges

$920,473

Drug: Age related quantity issue

Treatment charges

Treatment charges

$920,473

Orphan drug use

TOTAL

$12,782,683

Alt Site of Service

Top 10 Networks Insights

15-20X

in-house team productivity
proprietary surveillance nanoscripts
148000
questionable claim flag combinations
50000 +
new claims processed every hour
120000

How PredictPi compares with conventional solutions

Most vendors focus on right-sizing payments, not solving overpayment drivers. PredictPi takes you right to the source, so you don’t have to solve it again.

Financial 
review
Clinical 
review
Clinical 
verification
Correct 
payment
Root cause 
Identified
Future costs 
mitigated
PredictPi
Payment 
integrity 
vendors
Cost 
containment 
vendors
An insurance professional studies payment integrity outputs from AMS’s FACS Secondary code edits tool
An insurance professional studies payment integrity outputs from AMS’s FACS Secondary code edits tool

PredictPi Secondary Code Edits

Tired of the high costs and long timelines that traditional edit processes demand? This special-purpose PredictPi module makes NCCI and MUE edits easy, efficient, and affordable. To learn more, book a PredictPi demo and ask about solutions for secondary codes

More AMS payment integrity solutions

Itemized hospital bill that can be rapidly analyzed by the AI-Bill payment integrity solution from AMS
AI-Bill: Audit automation solutions
AI-Bill for itemized bill review instantly check I-BIlls against hundreds of “Not Separately Reimbursable” (NSR) policies and transform them into complete validation-ready worksheets – all in just 90 seconds. It supports 75+ readable I-BIll formats, with average savings of 30% per bill.
AI-Bill for Specialty Pharmacy and AI-Bill for Implants provide complementary support covering thousands of specialty drugs and millions of implants and medical devices.
Request demo
Hospital worker studying pricing estimates that can be rapidly analyzed by the PredictPx payment integrity solution from AMS
Hospital worker studying pricing estimates that can be rapidly analyzed by the PredictPx payment integrity solution from AMS
Predict Px: Hospital pricing analysis
This one-of-a-kind PREDICT tool integrates a trio of powerful financial benchmarks: Hospital price transparency data, health plan transparency in coverage data, and medicare pricing.
Predict Px triangulates all 3 to provide unprecedented price transparency, unlock new incremental savings in your payment integrity workflows, and offer you powerful leverage for contract negotiation.
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Revolutionize payment integrity with AMS solutions.

Claim savings more consistently and efficiently than ever with solutions built on our industry-leading PREDICT Platform.
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Female healthcare professional using her tablet to run payment integrity solutions from AMS
Female healthcare professional using her tablet to run payment integrity solutions from AMS

PREDICT Platform

Advanced Medical Strategies
50 Salem Street Building A, Suite 106 Lynnfield, MA 01940 USA

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