360 Health Systems
Payment Integrity Redefined

The ever-evolving and highly complex healthcare payment ecosystem is subject to tremendous pressure to reduce costs. When it comes to claims processing in healthcare, miscalculated deductibles, wrongly applied claims to accounts, incorrectly used contract payment rates, Fraud, Waste and abuse are some of the reasons why the payment integrity is compromised. Many of the initiatives, however, are counterproductive, ultimately leading to higher costs and lower-quality of care in the wake of increased errors and overpayments. In the midst of this downward spiral in the payment environment, the question is how do healthcare organizations contain costs and recover overpayments while uncovering a wider range of waste and errors in claims processing? 360 Health Systems has an answer to this. The Florida-based company provides an operational platform to promote claim payment integrity using its proprietary technology.

“360 Health System’s turn-key platform is built on a Software as a Service (Saas) model with AI Technology, allowing Healthcare Organizations to unite and manage all of their payment integrity efforts, streamlining their internal and external processes through one cost-effective automated solution,” begins Stanley Guilbaud, Founder and CEO at 360 Health Systems. The company offers health plans, TPA’s and Self-Insured in both government and private sectors an opportunity to seamlessly reverse billions of dollars that are paid incorrectly. “We help Healthcare Payor Organizations to minimize and reduce payments and billing errors to Hospitals, Physicians and Pharmacies,” he adds. 360 Health Systems’ solution is a user-friendly one stop shop application. Some of the features include Claim Repricing, Fee-Schedule lookups, claim scoring, Real- Time Financial and Operational reporting, Interactive dashboards, workflow and vendor management, advanced analytics with hundreds of algorithms powered by an AI technology and automated recovery module. 360 Health Systems is poised to transform the Healthcare Payment Integrity with an unprecedented access to the most cost-effective payment accuracy system available in the market today. Our proprietary analytics system processes millions of claims per day, analyzing 100% of paid Medical and Pharmacy claims automatically with minimal human interaction. The market averages 3% discovery payment accuracy with 50 to 60% of financial recovery, 360 Health Systems averages about 10% discovery with a 90% financial recovery.

The Pay and Chase recovery model is one that cannot be ignored, as it remains an enormous issue in the payor market, and there is no reason why overpayment recovery needs to continuously be a costly and an inefficient process

In an actual case, our system evaluated the heap of data from one of its clients losing millions of dollars annually, discovering approximately 18% of lost revenue. “The client went from recovering $30,000 to identifying approximately a million-dollar monthly and improve their payment processing by over 50% without increasing staff or administrative duties with our solution,” Guilbaud mentions.

What makes our system second to none is its unmatched accuracy, affordability, extensive analysis, coupled with its ability to increase productivity, providing advanced digital reporting, and root cause identification for better decision making. The automated overpayment recovery solution is uniquely positioned to provide its clients with an easy-to-use system to identify and recover wasteful billing errors and fraud, while improving its clients’ ROI. “The company is called 360 Health Systems for a reason as we designed our software to review pre and post payments, a 360-degree payment accuracy review,” says Guilbaud.

With AI driven technology, SaaS-based, and highly secured HIPAA Compliant software, the company will continue adding value proposition for all healthcare payers. “360 Health Systems’ team is comprised of the nation’s leading payment integrity experts and data scientists. Their contribution to refining the powerful real-time reporting with actionable insights has fueled the innovation behind the unique machine learning capabilities, that powers our software called PORA (Payor Overpayment Recovery Application)”, concludes Guilbaud.