01
Pre-Pay Review
AI-powered claim screening before adjudication. Catches billing errors, duplicate submissions, and clinical mismatches before a dollar leaves the fund — eliminating the costly cycle of pay-then-chase.
Six Capabilities
Each capability stands alone — but they are designed to be operated as one system. Pre-pay, post-pay, coding, payment accuracy, executive intelligence, and AI anomaly detection.
Differentiated Portfolio
Zero Gaps
ClaimReturn's portfolio covers every point of financial leakage across the claim lifecycle — from initial adjudication through final recovery.
02
Post-Pay Recovery
Systematic identification and recapture of overpayments already made. Our provider-first approach maintains relationships while maximizing recovery.
03
Clinical Coding Validation
Deep clinical review ensuring ICD, CPT, and DRG codes accurately reflect the documented care. Eliminates upcoding, unbundling, and miscoded services before they become costly disputes or compliance risk.
04
Payment Accuracy Optimization
Contract compliance, fee schedule auditing, and coordination of benefits review across all payer relationships. Ensures every payment reflects your actual contractual obligations — not provider assumptions.
05
Executive Intelligence
Board-ready dashboards and benchmark reporting that translate payment integrity data into strategic decisions. Track savings velocity, leakage by category, and ROI against industry benchmarks.
06
AI Anomaly Detection
Machine learning models trained on 200M+ claims identify fraud patterns, aberrant billing, and emerging schemes that rules-based engines miss.