Performant and CAQH Announce Strategic Partnership

Performant Healthcare Solutions (Nasdaq: PFMT) has partnered with the Council for Affordable Quality Healthcare (CAQH) to enhance payment integrity and coordination of benefits (COB) for health plans.

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12/21/2022 - 07:30 AM EST

LIVERMORE, Calif.--(BUSINESS WIRE)-- Performant Healthcare Solutions (Nasdaq: PFMT) (Performant), a leading provider of technology-enabled payment integrity, eligibility, and related analytics services, and Council for Affordable Quality Healthcare (CAQH), an industry alliance of nearly 1,000 health plans, 2 million providers, and other healthcare stakeholders working to solve healthcare business challenges, today announced a partnership to improve payment integrity and coordination of benefits (COB) programs for health plans, including regional and community-based health plans. This initiative reflects both organizations’ commitment to driving savings, claims accuracy, and administrative simplification.

The partnership leverages Performant’s proprietary software platform and services, and CAQH’s one-of-a-kind registry of member coverage information to enable participating health plans to identify third-party healthcare coverage before paying claims. This prospective approach improves payment accuracy and delivers significant savings for health plans within months. Both organizations have a long history of improving payment accuracy for health plans and providers, and saw an opportunity to provide regional and community-based health plans more tailored support.

“We are excited that our partnership with CAQH will enable Performant to help more health plans realize the incredible value of our COB solutions,” stated Simeon Kohl, president at Performant. “As part of broader payment integrity services, Performant will support health plans with COB implementations, provide comprehensive data services, and serve as an extension of the plan’s own technical and operations teams to help recognize savings that would otherwise be lost.”

“When more health plans integrate robust coordination of benefits into their operational and financial strategies, the whole industry benefits from avoided cost and inaccuracy,” said Tyler Ford, Vice President of Strategy for CAQH. “Performant shares our mission and this partnership will complement our efforts to coordinate patient benefits, reduce claims errors, and save costs for health plans serving millions of members across the country.”

About Performant Healthcare Solutions

Performant Healthcare Solutions is a leading provider of technology-enabled audit, recovery, and analytics services in the United States with a focus in the healthcare payment integrity industry. Performant works with healthcare payers through claims auditing and eligibility-based (also known as coordination-of-benefits) services to identify improper payments. The Company engages clients in both government and commercial markets. The Company also has a call center which serves clients with complex consumer engagement needs. Clients of the Company typically operate in complex and highly regulated environments and contract for their payment integrity needs in order to reduce losses on improper healthcare payments.

Powered by a proprietary analytic platform and workflow technology, Performant also provides professional services related to the recovery effort, including reporting capabilities, support services, customer care and stakeholder training programs meant to mitigate future instances of improper payments. Founded in 1976, Performant is headquartered in Livermore, California.

About CAQH

For more than 20 years, CAQH has helped nearly 1,000 health plans, 2.0 million providers, government entities and vendors connect, exchange information and operate more efficiently. CAQH technology-enabled solutions and its Committee on Operating Rules for Information Exchange (CORE) bring the healthcare industry together to make sharing business information more automated, predictable and consistent. CAQH Insights researches opportunities to reduce the burden of manual processes in healthcare administration. Visit www.caqh.org and follow us on Twitter: @caqh.