Headline Partner
AMS Intelligent Analytics
Website: http://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.
Platinum Partner
Healthcare Fraud Shield
Website: https://www.hcfraudshield.com/
Healthcare Fraud Shield specializes in fraud, waste, abuse, & error detection and payment integrity for healthcare payers nationally by efficiently stopping claims prior to payment, utilizing post-payment advanced analytics, artificial intelligence, and shared client data insights. We save health plans millions annually incremental to existing pre-payment processes using our unique and proven approach. HCFSPlatformTM offers the combination of targeted rules, artificial intelligence, and shared analytics across multiple payers resulting in higher ROI (up to 20:1 or more) compared to other vendors.
The HCFSPlatformTM was developed by industry leading healthcare subject matter experts and is a component of over 60+ clients including 7 of the 10 largest commercial insurers in the US. Our client satisfaction rating is exceptional with a net promoter score of 94 and client retention rate over 95%. HCFSPlatformTM is a fully integrated platform consisting of PreShield (prepayment analytics & claim review logic), PostShield (post-payment analytics), AIShield (AI-driven analytic insights), RxShield (pharmacy and pharmaceutical specific analytics), Shared Analytics, CaseShield (SIU/PI case management), QueryShield (ad hoc query and reporting tool), HCFSServices (data mining, investigative, and record reviews), and AuditPlusTM (Medical Record Review & SVRS).
Silver Partners
6 Degrees Health
Website: https://www.6degreeshealth.com/
- Pre Pay: Clean Claim Reviews/Itemized Bill Review
Leveraging decades of experience in clean claim reviews, clinical expertise, and next-generation, purpose-built software, we deliver industry-leading savings for health plans. Our proprietary review process evaluates every line item to identify billing errors and inconsistencies. Clinical reviews are completed by our team of highly trained and experienced registered nurses to ensure each billed line item is appropriate for reimbursement. White glove service is provided throughout the entire process from obtaining the itemized bill through any appeals and customized reporting.
- Post Pay: Data Mining and Recovery
We provide comprehensive overpayment identification and recovery solutions for Medicare Supplement, Dental, and Medical. Relying on over 20 years of concept creation, we identify 1-2% of total paid claims as overpayments. Our robust and unique recovery solution recovers 80 - 90% of overpayments as low as $25 with no provider abrasion. We have deployed solutions to 5 of the top 10 Med Supp carriers, and to 2 of the top 5 Dental carriers.
Lyric
Website: https://www.lyric.ai/
Lyric is a platform-based healthcare technology company, committed to simplifying the business of care by preventing inaccurate payments and reducing overall waste in the healthcare ecosystem. Lyric, formerly ClaimsXten, is a market leader with 35 years of pre-pay editing expertise, dedicated teams, and top technology. Our solutions leverage the power of technology and advanced analytics to maximize value. Discover more at Lyric.ai.
Optum
Website: https://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: https://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
Ceris Health
Website: https://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.
Penstock
Website: https://www.penstockgroup.com/
Penstock is a payment integrity partner purpose-built for health plans and integrated health systems. As consolidation reshapes the industry, many vendors have shifted focus toward volume and automation. Penstock takes a different approach—delivering the attention, accuracy, and innovation today’s health plans deserve.
Our team of industry veterans brings decades of clinical, coding, and regulatory expertise—backed by proprietary technology that empowers smarter, faster, and more transparent audits. From first-pass to deep, multi-pass reviews, we uncover savings others miss while helping reduce provider abrasion.
Our internal platform, ClearBridge, was developed by auditors, for auditors—enabling real-time logic visibility, streamlined workflows, and smarter outcomes at every stage of review.
Recognized as one of the fastest-growing companies in payment integrity and Best Place to Work, Penstock is powered by people who love what they do—and it shows in the results we deliver.
