Partner with SamITHealth — transform payer operations
Talk to our payer experts about audits, pilots and managed services tailored to your needs.
Payer Solutions
Innovative, compliant & data‑driven payer operations
Empowering payers and TPAs with analytics, automation, and process maturity (CMMI‑aligned) to improve claim accuracy, reduce denials, accelerate reimbursements, and enable scalable, auditable operations.
MAO & Risk Adjustment
Accurate HCC coding, risk score optimization and audit-ready workflows for Medicare Advantage and managed plans.
Claims Management & TPA Support
End-to-end claim lifecycle management, rule-based adjudication and third‑party administrator integration.
Medical Review & Repricing
Data-driven repricing, clinical review and provider engagement to contain costs and ensure fair pricing.
Workers' Comp & Auto Claims
Specialized workflows, compliance controls and adjudication tailored for workers' compensation and auto insurance.
Form Conversion & Interoperability
Automated CMS‑1500/UB‑04 conversion, EDI mapping and system harmonization for cleaner feeds.
Analytics & AI
Predictive analytics, denials root-cause and AI-assisted coding to continuously improve operations.
Executive Summary
Typical projects deliver rapid ROI through prioritized repricing, denial automation and targeted provider education — our pilots show recoveries within 90 days and recurring net benefit thereafter.
Request executive brief →Financial Impact (Quick estimate)
Use the quick calculator to estimate annual recovery opportunity.
Risk Heatmap & Roadmap
We prioritize remediation and automation where spend, leakage and regulatory risk overlap. Typical roadmap: Pilot → Scale → Automation → Continuous monitoring.
- Phase 1: 90-day claims pilot (sampling + analytics)
- Phase 2: Repricing + appeals & provider remediation
- Phase 3: Automation & controls embedded into adjudication
Advanced Visualizations
Claims Trend (reported vs resolved)
Volume and throughput — hover to inspect days with spikes and backlog.
Denials by Reason
Identify top categories for automation and templated appeals.
Payment Accuracy by Provider
Spot providers needing audit or documentation coaching.
Remediation Pipeline
Track remediation stages, owners and ETAs for SLA reporting.
Live wiring available: API, Snowflake, BigQuery, S3 — we can build scheduled exports, PDF reports and role-based dashboards for your teams.