Headline Partner
AMS Intelligent Analytics
Website: 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.
Find out more: https://pricetransparency.com/
AI Knowledge Partner
Optum
Website: 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.
Platinum Partner
Alaffia Health
Website: www.alaffiahealth.com
Alaffia is a new kind of health plan operations partner. We use expert clinicians and transparent AI to elevate your end-to-end claims operations with deeper insights, smarter automation, and consistently better outcomes across the entire claims lifecycle. Our solutions support Utilization Management, Payment Integrity, and Appeals—giving your teams the clinical context and operational intelligence they need to work faster and drive consistently better outcomes.
Healthcare Fraud Shield
Website: www.hcfraudshield.com
Healthcare Fraud Shield (HCFS) is a leading provider of fraud, waste, abuse, and error (FWAE) detection and payment integrity solutions for healthcare payers nationwide. Our platform stops improper claims before payment and detects issues after payment using advanced analytics, AI, and shared intelligence from a broad client network. With over 14 years of exclusive focus on FWAE and payment integrity, HCFS was built by industry experts to deliver measurable results. Clients typically achieve an average up to 10:1, and higher when leveraging HCFS Services.
Why HCFS:
- Enterprise-wide SaaS solution – Used by health plan teams across SIU/FWA, Payment Integrity, Risk, UM, Claims, Legal, Operations, and Finance
- 2,100+ FWAE rules – The largest FWAE rule library in the industry
- AI + Human-in-the-Loop – 11 AI models (FWA360Leads, AIShield, RecordPlus), all expert-validated
- Shared Analytics – Insights from 95M+ members across plans to uncover new, high-value cases beyond internal data
- 85+ external data sources – Enrich claims data for more precise detection
- Trusted by 70+ clients, including 7 of the 10 top commercial payers and 3 of the 5 of the top national payers
Lyric
Website: www.lyric.ai
Lyric is the payment integrity Al company trusted by the nation's leading health plans at the beginning of the claims payment workflow. The Lyric platform is built on Al from the ground up and trained on 35 years of clinical expertise with real time integrations across 190 million lives. Lyric reduces wasted healthcare spending and ensures fast, accurate payments that drive transparency between payers and providers. Lyric is recognized as the 2025 Best in KLAS for Pre-payment Accuracy and Integrity.
Gold Partners
Machinify
Website: www.machinify.com
Machinify is the healthcare intelligence company helping health plans improve payment accuracy and efficiency across pre- and post-pay. Deployed by 85+ plans and representing 270M+ lives, Machinify's platform operating system combines AI with clinical, coding, and policy expertise to make better decisions at scale. We support COB, subrogation, itemized bill review, DRG audits, pharmacy, and data mining across commercial and government programs.
RevCycle Experts
Website: www.rcxcorp.com/Payer
Bridging the gap between Provider claims and Payer reimbursements
The complexity of healthcare claims requires a partner like RCX. RCX helps detect suspicious payment trends and target claims with the highest potential for waste, fraud and abuse. Our seasoned physicians, CDI nurses, and certified coding and DRG validators comprehensively review claims to ensure the accuracy of diagnoses, procedures, coding, and DRG assignment submitted on hospital claims.
Our team of 32 professionals brings a combined 100+ years of healthcare documentation, coding, and DRG auditing expertise, delivering a strict yet fair validation process that safeguards health insurance companies' revenue — without disrupting clients' processing turnaround time.
RCX has partnered with leading healthcare payers and auditing firms to help organizations reduce inaccurate claim payments, whether caused by provider processing errors, fraud, or abuse. In a recent 24-month engagement, RCX audited over 15,000 cases, recovering $3.4 million in net revenue and delivering a 75% ROI.
Shift Technology
Website: www.shift-technology.com
Shift Technology empowers health plans to strengthen payment integrity with precision, fairness and speed at critical steps of the claim lifecycle. With a continually optimized concept library, enriched data, and advanced, healthcare-trained AI, Shift detects and helps plans prevent errors and improper payments to maximize savings. Our SaaS-based solutions drive accelerated and insightful decision-making, helping health plans reduce costs and enhance operational efficiency.
Community Partner
Avelis Health
Website: www.avelishealth.com
Avelis Health deploys machine learning models to identify and recover overpayments on medical claims. Our AI call center does automated outreach to providers to handle the entire post-payment recovery and dispute process. We work with TPAs, health plans, and payment integrity vendors.
CGI
Website: www.cgi.com/us/en-us
Founded in 1976, CGI is among the largest IT and business consulting services firms in the world. We are insights-driven and outcomes-based to help accelerate returns on your investments. Across hundreds of locations worldwide, we provide comprehensive, scalable and sustainable IT and business consulting services that are informed globally and delivered locally.
Nokomis
Website: 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
Website: 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.
Katch
Website: katchiq.com
Katch is the industry leader in payment coordination, offering end-to-end solutions from Proactive Injury Coverage Coordination (PICC) to subrogation.
Katch gives you more from every claim: more value, more savings, and more confidence in the process.
By combining human insight with data and technology, we deliver smarter outcomes—before and after claims are paid. We tailor our strategies to each client’s unique needs, building partnerships that create real impact.
Katch finds what others miss—earlier, faster, and easier.
- 35+ years of subrogation experience
- Supporting 100+ clients across all 50 states
- Scaled solutions for PICC and subrogation
Proactive By Design
Penstock
Website: www.penstockgroup.com
Penstock is a high-performance payment integrity partner built for health plans that demand more—from their partners and their results. We work with national and regional health plans to restore the depth, attention, and transparency that has been lost in today’s increasingly consolidated payment integrity landscape.
Our human-led, auditor-controlled model combines deep payment integrity expertise with advanced data mining to uncover what others overlook. Every finding is grounded in plan-specific policy, contract language, and defensible logic—designed to hold up under audit, appeal, and regulatory review. The result is real dollars recovered, recurring issues addressed at the source, and sustained improvements in payment accuracy.
Penstock’s post-pay work functions as a plan’s research-and-development engine for pre-pay. Through deep post-pay audits and ongoing data mining, our teams generate 4–6 new claim overpayment concepts each month. By analyzing claims with full context and clinical nuance, we identify not just individual claim overpayments, but the systemic patterns behind them—providing the insights plans need to strengthen pre-pay controls and prevent future leakage.
As payment integrity vendors consolidate and innovation stalls, health plans turn to Penstock for precision, accountability, and results that compound over time. Ranked No. 353 on the 2025 Inc. 5000 list—top 50 in healthcare—and named the fastest-growing private company in the Northeast, Penstock is redefining what defensible, modern payment integrity should look like.
