List of Claritev Payment & Revenue Integrity Customers
New York, 10003, NY,
United States
Since 2010, our global team of researchers has been studying Claritev Payment & Revenue Integrity customers around the world, aggregating massive amounts of data points that form the basis of our forecast assumptions and perhaps the rise and fall of certain vendors and their products on a quarterly basis.
Each quarter our research team identifies companies that have purchased Claritev Payment & Revenue Integrity for Payment Integrity from public (Press Releases, Customer References, Testimonials, Case Studies and Success Stories) and proprietary sources, including the customer size, industry, location, implementation status, partner involvement, LOB Key Stakeholders and related IT decision-makers contact details.
Companies using Claritev Payment & Revenue Integrity for Payment Integrity include: Health Net, a United States based Insurance organisation with 3000 employees and revenues of $2.50 billion, TakeCare Insurance Company, a Guam based Insurance organisation with 200 employees and revenues of $40.0 million and many others.
Contact us if you need a completed and verified list of companies using Claritev Payment & Revenue Integrity, including the breakdown by industry (21 Verticals), Geography (Region, Country, State, City), Company Size (Revenue, Employees, Asset) and related IT Decision Makers, Key Stakeholders, business and technology executives responsible for the software purchases.
The Claritev Payment & Revenue Integrity customer wins are being incorporated in our Enterprise Applications Buyer Insight and Technographics Customer Database which has over 100 data fields that detail company usage of software systems and their digital transformation initiatives. Apps Run The World wants to become your No. 1 technographic data source!
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| Logo | Customer | Industry | Empl. | Revenue | Country | Vendor | Application | Category | When | SI | Insight |
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Health Net | Insurance | 3000 | $2.5B | United States | Claritev | Claritev Payment & Revenue Integrity | Payment Integrity | 2003 | n/a |
In 2003, Health Net implemented Claritev Payment & Revenue Integrity to centralize Payment Integrity functions across claims operations and payments. The Claritev Payment & Revenue Integrity deployment was positioned to support claims adjudication, payment validation, and revenue integrity oversight for operations, finance, and provider relations teams.
The implementation included standard payment integrity modules consistent with the category, including a rules engine for claim edits, claims analytics for anomaly detection, case management for recovery and appeals workflows, and high-dollar claim review support to assist supervisory reconciliation. Claritev Payment & Revenue Integrity was configured to surface edit alerts, route recovery cases, and provide audit trails aligned with operational controls used by claims supervisors and examiners.
Operational integration focused on connecting the Payment Integrity layer with core claims processing and payment posting systems, provider data sources, and internal reporting repositories to enable end-to-end detection and recovery workflows. The deployment covered claims operations, provider relations, and payment posting functions, with system access calibrated for examiners, supervisors, and finance analysts.
Governance emphasized process standardization and role-based workflow changes, including formalizing review and approval procedures for high-dollar claims and creating training protocols for supervisors and claims examiners. The implementation reinforced systematic case routing and reconciliation practices used by staff who negotiated provider payment terms and reconciled high-value claim payments.
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TakeCare Insurance Company | Insurance | 200 | $40M | Guam | Claritev | Claritev Payment & Revenue Integrity | Payment Integrity | 2022 | n/a |
In 2022, TakeCare Insurance Company implemented Claritev Payment & Revenue Integrity to establish a Payment Integrity capability for claims and revenue workflows covering its membership of federal employees, annuitants, and their dependents. The deployment was scoped to support TakeCare's expanded in-network access across the Continental US and Hawaii and to operate against the insurer's contracted provider footprint, which includes named facilities such as Cedars-Sinai Medical Center, Mayo Clinic Health System, MD Anderson Cancer Centers, The Queen's Medical Center - Hawaii, and UCSF Medical Center.
Claritev Payment & Revenue Integrity was configured with category-aligned modules for claims analytics, pre-pay and post-pay reviews, coding and billing validation, and provider bill review, using a rules-driven adjudication engine to surface payment anomalies and coding discrepancies. Implementation included configuration of automated edit sets, workflow orchestration for adjudicator review, and case management capabilities to track investigations and recoveries, aligning system taxonomies with TakeCare's claims data model.
Operational coverage was designed to mirror TakeCare's network affiliations and direct provider contracts, processing claims for in-network services and incorporating business rules that respect the insurer's prior authorization policy for off-island elective non-emergency services. The rollout emphasized interoperability with claims adjudication feeds and provider billing streams, enabling the Claritev Payment & Revenue Integrity solution to receive claim-level data and produce review queues and exception reports for downstream claims operations.
Governance for the Payment Integrity program was formalized to centralize audit and review processes, with configuration change controls for rule sets and established escalation paths for provider disputes and billing errors. The implementation narrative centers on embedding Claritev Payment & Revenue Integrity into TakeCare's claims lifecycle, aligning analytic and operational workflows to the insurer's expanded network and prior authorization protocols.
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Buyer Intent: Companies Evaluating Claritev Payment & Revenue Integrity
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