Performant Healthcare Solutions

Performant’s Healthcare Division offers broad experience with commercial and government payers providing payment integrity services to national health plans, regional health plans and Blue Cross Blue Shield plans, as well as the industry’s largest payer, the Centers for Medicare and Medicaid Services (CMS).To support a health plan’s cost containment efforts, Performant offers a comprehensive suite of solutions, including claim audit, third-party liability (TPL) services, data analytics, and recovery services for commercial, Medicare, and Medicaid lines of business. These services include data mining and clinical review audits of inpatient and outpatient claims, identification and recovery of Medicaid and Medicare TPL, and Medicare premium enhancement. Our experienced team of registered nurses, certified coders, claims examiners, and audit analysts have a deep understanding of the entire claim payment lifecycle and perform audits under Medical Director supervision. Our healthcare recovery specialists are trained to help payers recoup overpayments from both providers and carriers.In the public sector, Performant serves as a CMS Recovery Audit Contractor (RAC) for Region 1 and as the sole RAC for Region 5, the national region for DMEPOS, Home Health and Hospice claims audits. To date, Performant has facilitated the return of more than $1.8 billion to the Medicare Trust Fund. Performant also serves as the national vendor for the CMS Medicare Secondary Payer Commercial Repayment Center (MSP CRC) responsible for identifying and recovering payments from other carriers when Medicare should not have been the primary payer.Staffed by more than 1,300 employees, Performant serves a diverse portfolio of clients across all 50 states, U.S. territories, and internationally with program spend ranging from a few hundred million to billions of dollars per client.