Own the Rules! Keep 100% of the Savings.

Paytegrity Prepayment Unified Defense System

Non-Intrusive, Intelligent Prepayment Overlay

The Paytegrity PayRight℠ Unified Defense System operates as a quiet, upstream gatekeeper between your core adjudication system and final remittance. It intercepts billing and clinical variances before funds leave your door—with zero core system disruption and zero PHI egress.

• Zero Core Disruption: Evaluates standard extracts downstream; no core engine modifications.
• Zero PHI Egress: Operates 100% within your private cloud perimeter. Data never leaves.
• 80% Medical Spend Coverage: Inpatient MS-DRG, Outpatient APC, ASC, BHSUD, and High-Cost Drugs across 35+ claim types.
• 100% Value Retention: Capture immediate cost avoidance internally without recurring contingency deductions.

The Adjudication Nexus: Built for Modern Healthcare Velocity

Over two decades ago, legacy contingency models delivered essential value. They built vital operational scale that bridged administrative complexities. Trading a contingency share was a sensible default.

Today, the adjudication layer demands a new defense.

The velocity of modern healthcare—driven by highly tailored provider contracts,
evolving risk-sharing arrangements, statutory interoperability mandates, and narrowing margins—requires real-time, in-house controls.

Contingency arrangements create dependency on recurring billing errors rather than root-cause prevention. While contingency appears low-risk on the surface, trading 20% to 25% of your plan’s identified savings is a recurring tax on administrative efficiency.

The Quiet, Intelligent Gatekeeper

PayRight sits quietly between final claim adjudication and fund release. By executing pre-calibrated clinical and contractual audit logic directly over standard output extracts, your internal team intercepts variances before disbursements leave your accounts.

• Sovereign Oversight: Integrates smoothly alongside your existing vendor stack. Your in-house clinical, coding, and payment integrity teams own the rules, calibrate thresholds, and govern outcomes.
• 100% Value Retention: Capture immediate cost avoidance internally, keeping every dollar identified right where it belongs.
• Rapid, Contained Validation:Proven ROI in 60 days or less. Implements in weeks, not quarters.

Don’t Take Our Word

Inpatient DRG Governance & Clinical Validation

Inpatient facility claims carry the highest clinical complexity and financial risk across any health plan’s spend. A single variance in principal diagnosis sequencing, procedural coding, comorbidity validation, or discharge disposition can shift claim costs by tens of thousands of dollars.

Comprehensive Adjudication & Clinical Record Intelligence

Our MS-DRG platform combines deterministic regulatory validation our trained proprietary H-I-T-L AI to examine the entire claim lifecycle:

• Holistic Coding Integrity: Validates Principal Diagnosis (PDx) selection, principal procedure coding, secondary CC/MCC validity, and discharge disposition across the entire claim.
• Agentic Clinical Record Review: Uses evidence-grounded clinical intelligence to cross-reference physician orders, operative reports, progress notes, and discharge summaries directly against established clinical policy and statutory guidelines.
• Instant Financial Calculation: Calculates billed vs. audited relative weights in real time against CMS groupers, providing immediate visibility into allowed variances.
• Rapid Deployment: Ready to run against historical extracts or active prepayment holding streams within days.

Paytegrity PayRight℠ Solutions – The Undeniable PI Choice

Paytegrity PayRight℠ Solutions — The Undeniable PI Choice

Adopting a modern, intelligent prepayment overlay doesn’t require a multi-quarter core system overhaul or handing over 25% of your plan’s recoveries.

PayRight was engineered around a simple premise: Map. Connect. Use.

• Zero Security Delays (No PHI Egress): Operates 100% within your private environment. Because clinical records and claim extracts never leave your perimeter, your team avoids prolonged multi-tenant vendor risk and data-sharing reviews.
• Non-Intrusive Adjudication Overlay: Sits quietly between adjudication and payment release. Evaluates standard daily extracts without altering or disrupting your existing core claims platforms or vendor contracts.
• Immediate Operational Depth: Deploys with over 300 pre-calibrated clinical, facility, and coding audit detectives across 35+ claim types, paired with end-to-end case management, shadow re-pricing, and appeal tracking.
• 100% Value Retention: Capture immediate cost avoidance before checks are disbursed. No recurring contingency splits. No multi-year recovery lag.