True Payment Integrity – Less Infighting and More Insight
Tension, fighting, and finger-pointing between payers and providers has become the norm, but it doesn’t have to be this way. By collaborating to make reimbursement more accurate, we can avoid conflict and focus on what really matters – healing.
Payment INTEGRITY
Ensure every payment is right the first time—delivered with precision, transparency, and care.
TREND delivers intelligent, AI-powered payment integrity services that improve payment accuracy, ensure contract compliance, and strengthen payer-provider partnerships—driving better outcomes with less friction.
More Recoveries, Faster to Results
+16% recoveries in one month
+65% recoveries in 2nd pass, +27% in 3rd pass in six months
98% human accuracy rate, 96% AI accuracy in automations
Payment Integrity
Get payments right the first time with AI-enabled data mining, claims intelligence, and contract compliance.
✓ Identify non-clinical overpayments
✓ Improve root-cause detection
✓ Reduce waste and leakage
Coordination of Benefits (COB)
✓ Capture other coverage details early
✓ Prevent duplicate payments
✓ Prevent duplicate payments
✓ Streamline recovery across payers
Clinical Services
Deliver precision with clinician-led reviews.
✓ DRG validation
✓ Itemized bill review
✓ Medical necessity determination
✓ Reduce provider abrasion with smart claim selection
Contract Compliance
✓ Detect and correct overpayments due to contract misalignment
✓ Protect payer margins and provider trust
Technology Differentiator
✓ Analyze structured + unstructured data (policies, contracts)
✓ Provide clear, root-cause reporting
✓ Support continuous process improvement
Our Collaborative Approach
✓ Reduce provider abrasion
✓ Increase provider cooperation
✓ Maintain trust on both sides
Avoid Conflict & Reduce Waste by Improving Payment Integrity
Providers Receive Accurate & Timely Reimbursements
By aligning processes, providers reduce errors and receive more accurate and timely reimbursements.
Payers Reduce Overpayments
Through open communication and data sharing, claims are processed faster and more accurately, reducing overpayments.
Everyone Saves Time & Money
By collaborating, payers and providers both save money by reducing the number of claim denials and minimizing the need for costly rework or appeals.
The Problem
Improper Payments Are at the Center of Waste & Rising Costs
Disputes over payments make healthcare less efficient, and the way the industry approaches improper payments today is making the problem worse.
Improper payments increase the cost of healthcare..
Underpayments lead to financial shortfalls for providers, overpayments create credits and lead to financial losses for payers, all resulting in increased operational and administrative costs.
Everybody loses when payments are incorrect.
Be it underpayments or denials, providers lose revenue when claims are not paid or if the appeals process is unsuccessful. And overpayments require payers to recoup overpaid funds, adding to operational cost and complexity.
Improper payments damage payer/provider relationships.
Constant disputes over payments deteriorates trust and weakens relationships between healthcare payers and providers, worsening outcomes for all parties.
Less transparency means more payment errors.
Limited visibility into payer payment methodologies or denial reasons makes it difficult for providers to predict and prevent billing errors. And poor communication with providers regarding claim errors or payment rules creates inefficiencies in addressing and correcting payment issues on the payer side.
Without good data, you can’t make good decisions.
Inaccurate or incomplete coding, documentation, or claim submissions cause discrepancies that result in payment errors for providers and additional review from payers – increasing processing time and causing delays in adjudication and payment.
Incorrect payments put regulatory and contract compliance at risk.
Payers must ensure that payments adhere to regulatory guidelines while providers must comply with payer rules and regulations. Inaccurate payments, whether overpayments or underpayments, can expose both payers and providers to legal scrutiny, fines, and regulatory penalties, as well as damage their reputation and compliance track record.
$170B in claims are paid in error every year…
According to CMS, more than $170 billion in claims are paid in error every year due to the complexity of our healthcare delivery systems. This is equivalent to more than 7% leakage coming from the commercial market and 10% from the governmental market.
TREND deploys an advanced technology platform and proven claims data modeling techniques to drive the identification, validation and resolution of payment errors at scale.
Powering Payment Integrity with Intelligent Collaboration
TREND’s payment integrity solution leverages AI technology and data analytics to efficiently identify, recover, and prevent overpayments while also offering expert analysis to identify potential overpayments, root causes, and mitigation opportunities.
Works claims most likely to yield a refund
No thresholds for low dollar or high complexity
Uncover new content; underserved areas
Identify and deliver automation opportunities
Move left to pre-pay, insource
Reduce vendor spend / BPO costs
26x
Faster Audits
98%
Accuracy Achieved
38%
Reduction in Cost
Move Beyond Data Mining with Collaborative Claims Intelligence
Monthly Status Report
Details your claim inventory status, providing a claim roll-up of the activity taken on the claims, where they currently reside in the process, and final claim resolution.
On-Trend Report
Case-by-case review to determine appeal opportunities. Aggregates and outlines the story of your denials plus our recommendations for addressing root causes.
Executive Summary
Overviews metrics for designated period and may show trends not easily seen within the project. Helps escalate any issues or opportunities for both TREND and client.
Infographic Reporting
Illustratively depicts claims appealed and recovery results. Specific graphs can include appealed amounts by payer and/or denial type plus closures by reasons and/or payers.
No Sides, Just Solutions.
It's Better in the Middle.
Serving as a mutual partner to both payers and providers creates significant advantages as measured in claims payment rates, denial overturn rates and overall claim resolution speed. Both sides benefit from cleaner claims and faster overall processing.
Payers and providers partnered with TREND both spend less money and fewer resources on resolving claims. Trend has visibility to the rules and procedures and on both sides, eliminating the struggles of the old way.
The TREND Difference
The Old Way is Failing.
It’s Time for a New TREND.
We take a different approach to payment integrity – blending innovative tech, expertise, and customer centric philosophy.
TREND
Proven AI Engine, Machine-Learning + SMEs
Train the engine on plan-specific policies, provider contracts, outcomes from vendors
New recoveries, New content; Automation
Other Vendors
Low Technology
False positives
Operate in a black box
Membership Integrity
Payers, It’s Time to Transcend Traditional COB
Accurately identify members with unknown Medicare coverage, whether or not they have claims.
Membership Integrity
Accurately identify members with unknown Medicare coverage whether or not they have claims.
Break Out of Traditional COB
- Avoid vendors holding on to coverage changes until large claims come in
- Minimize reliance on COB vendors overall
- Reduce fees
- Prevent future COB
- Eliminate abrasion associated with post-pay COB
Getting started with Membership Integrity on its own or add COB Data Mining support
Membership Integrity
- Use typical claims data feed from plan
- Receive identified Medicare members with direct CMS information
- Pass to internal team to update, validate recoveries and generate results
Add to COB Data Mining
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Add validation, primacy determination, and COB services to generate recoveries.
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Add to existing Data Mining implementation seamlessly
Get better results, new concepts, automated intelligence
Credit Balance for Medical Billing
End the Credit Chaos
Stop letting credit balances drain your resources and pit payers against providers. TREND’s first-of-its-kind solution tackles credits at the root, bringing teams together to fix overpayments, streamline refunds, and keep healthcare moving forward — without the usual tug of war.
Case Study
Plan Overview
Single-state BCBS Plan
Number of Members: ~3 Million Lives
Key Value Drivers
6 months in production
Health plan finds TREND’s workflow/reporting easy to use
Claims go from identified to retracted savings in 9 days
Reduced the health plans’ time to support by 45%
65% increase in Gross Recoveries
320% increase in average claim recovery
98% accuracy rates achieved
Annualized Recoveries
