CBA Health Alliance, LLC delivers an automated payment (pre and post) and program integrity solution via a mandatory national Clearinghouse that revolutionizes fraud, waste, and abuse detection in Medicaid, Medicare, private health plans, and self-funded plans (both government and private). It mandates pre-payment scrubbing of every claim using real-time auditing, advanced machine learning analytics, and comprehensive oversight to flag errors, outliers, and questionable patterns (e.g., sloppy coding or overbilling), projecting 8-9% annual savings per $100 billion in spending.
CBA Health Alliance, LLC performs in-depth audits and recovery operations by analyzing 100% of claims across Medicaid, Medicare, private health plans, and self-funded plans to identify improper payments, such as duplicates or upcoding. Through outlier identification, targeted interventions, and reporting tools, they enable the recovery of overpayments, deter future abuse, and generate revenue by reducing errors, with potential savings scaling to billions annually based on historical improper payment rates.
CBA Health Alliance, LLC provides expert consulting services to states, providers, payers, and administrators in Medicaid, Medicare, private health plans, and self-funded plans. This includes guidance on integrating payment integrity systems, refining billing practices, deploying machine learning for fraud detection, and achieving scalable nationwide deployment, helping clients enhance accountability and operational efficiency.
CBA Health Alliance, LLC ensures regulatory compliance for healthcare claims in Medicaid, Medicare, private health plans, and self-funded plans by routing all submissions through their Clearinghouse for mandatory review. It flags non-compliant issues like incorrect coding or bypassing TPAs in real-time, offers continuous algorithm refinement to minimize false positives, and provides dashboards for tracking trends, thereby strengthening oversight and public trust.
CBA Health Alliance, LLC verifies beneficiary and provider eligibility in Medicaid, Medicare, private health plans, and self-funded plans as part of their pre-payment Clearinghouse process. Using integrated systems and advanced analytics, it confirms enrollment status, prevents payments to non-eligible parties, and identifies patterns of abuse related to eligibility fraud, ensuring efficient processing of legitimate claims while reducing waste.