Case Study: a regional payvider achieves $30M in savings with Alaffia Health

Regional Payvider realizes $30M in savings with Alaffia Health

A regional managed care plan, often referred to as a payvider, faced the challenge of building a payment integrity program from scratch. Without the internal resources or expertise to scrutinize claims for billing errors, they were leaving millions in potential savings unclaimed. They partnered with Alaffia Health to implement its managed services for both pre-payment and post-payment audit reviews.

Alaffia implemented a comprehensive solution using AI-enabled review logic and expert clinical validation to audit claims. This resulted in $30M in cumulative savings, split between $18M in recovered post-pay savings and $12M in pre-pay cost avoidance. The program also maintained an overturn rate of under 1%, strengthening provider relationships while saving money.