Medicare and Medicaid improper payments total over $60 billion annually, while quality outcomes have flatlined. Better data infrastructure can change this — protecting funding and improving care for the people these programs serve.
CMS CERT reports show persistent 6-7% error rates year after year, totaling roughly $31 billion annually.
PERM data shows Medicaid improper payment rates as high as 21% in recent years, representing tens of billions in waste.
Readmission rates, hospital-acquired infection rates, and CMS penalty rates have barely moved since 2020 despite billions in consulting spend.
Trusted infrastructure for the organizations that oversee healthcare programs.
From claims analysis to network oversight, Guardian agents autonomously monitor, detect, investigate, and route — so your team focuses on decisions, not data wrangling.
Detection and investigation of billing anomalies, payment accuracy risks, and claims outliers across Medicare and Medicaid programs.
Continuously evaluate encounter data completeness, flag data-quality gaps across MCOs, and surface corrective insights for your Medicaid or Medicare program.
Continuous monitoring of managed care organization performance metrics, utilization patterns, and program compliance across your entire network.
Comprehensive provider network oversight — from utilization patterns to provider benchmarking and network integrity evaluation.
Maintain audit readiness and proactively detect program integrity risks before they become federal findings.
Continuously evaluate the safety, accuracy, and fairness of clinical AI tools deployed across your network — from prior authorization models to clinical decision support.
Detection and investigation of billing anomalies, payment accuracy risks, and claims outliers across Medicare and Medicaid programs.
Traditional program integrity approaches rely on periodic sampling and manual review. ChartR replaces that with autonomous, always-on monitoring.
Real-time visibility into program integrity risks, encounter completeness, and MCO performance across your entire Medicaid program.
Autonomous payment integrity detection and investigation workflows that surface the signal from millions of claims.
Continuous monitoring of encounter submissions, quality metrics, and regulatory requirements.
Cross-program performance analytics and trend detection across Medicare and Medicaid populations.
Scalable peer review workflows with automated case identification, evidence compilation, and outcome tracking across your network.
AI-powered investigation support that builds evidence chains, scores provider risk, and prioritizes cases for your special investigations unit.