Meta Description: Discover how Avelis Health’s automated auditing solutions enhance healthcare reimbursement accuracy and maximize claims recovery for insurers and payers.

In today’s fast-paced healthcare world, even a small error on a claim can drain millions from your bottom line. Insurers and self-insured employers face a common headache: improper payments. The good news? You don’t have to accept that loss. Let’s compare two big players in medical claims auditing and see how Avelis Health can help you achieve true healthcare reimbursement accuracy.

Why Claims Auditing Matters

Every year, up to 7% of medical claims carry errors. That equals:

Overpayments on routine procedures.
Missed refunds for billing mistakes.
Hidden costs buried in dense paperwork.

You might be thinking: “We have an audit process already.” Great. But what if that process catches only half of the errors? Or demands weeks of manual review? That’s where advanced solutions step in—boosting your healthcare reimbursement accuracy and returning real dollars to your plan.

Side-by-Side: CGI ProperPay vs Avelis Health Automated Auditing

Features & Benefits	CGI ProperPay	Avelis Health Automated Auditing
Recovery Track Record	$200M+ recovered by focusing on DRG claims	Typically 3–7% of total spend recovered across all claim types
Review Process	Complex-audit-review with manual steps	Full AI-driven error detection on 100% of post-paid claims
Integration	Requires workflow restructuring	Seamless plug-and-play with existing claims systems
Real-Time Visibility	Periodic reports	Interactive Real-Time Savings Dashboard
Appeals Management	Case management module	Comprehensive Appeals Management with full support
Preventive Feedback	Proactive edit library updates	Automated insights and rule tuning to prevent future errors
Compliance Focus	High compliance standards	ERISA-compliant auditing with member interest protection

CGI ProperPay: Strengths and Limitations

Strengths
– Proven track record: over \$200 million recovered.
– Focused on Inpatient DRG claims.
– Case management for fraud, waste, and abuse.

Limitations
– Manual workflows slow down turnaround.
– Limited visibility between audit cycles.
– Integration can be complex for health plans.

Avelis Health Automated Auditing: The Better Fit

Key Differentiators
– AI-Powered Payment Integrity Solution: Scans every claim instantly, catching nuanced errors that slip through manual reviews.
– Real-Time Savings Dashboard: See adjustments, billing errors, and savings trends as they happen.
– Comprehensive Appeals Management: We handle the entire appeals process, so you don’t lose another cent to denied corrections.

“With Avelis, our auditing felt like switching from a flip phone to a smartphone.”

That’s how one self-insured employer described the jump in healthcare reimbursement accuracy after integrating our AI solution.

How Avelis Drives Healthcare Reimbursement Accuracy

Seamless Integration
Connect in days, not months. No disruption to your existing claims engine.
AI-Driven Error Detection
Think of it as a metal detector for billing errors. It never gets tired.
Automated Post-Payment Audit
Every paid claim goes through a second pair of digital eyes—24/7, 365 days a year.
Actionable Insights
Receive weekly tune-ups. Our system learns, adapts, and improves your edit library in real time.
Full Appeals Support
From provider notification to final resolution, we manage the back-and-forth for you.

Real Results, Real Savings

A large commercial payer using CGI’s tool recovered \$200 million. Impressive, right?
With Avelis Health, one health plan saw a 5% reduction in annual spend within six months.
Another self-insured group cut overpayments by \$3 million in their very first quarter.

The outcome? Fewer surprise costs. Happier members. Better premiums. And, of course, sky-high healthcare reimbursement accuracy.

Choosing the Right Partner

You want a partner, not just a vendor. Here’s why Avelis Health stands out:

AI at the Core: Our machine learning algorithms evolve with billing rules.
Dedicated Support: A team that knows ERISA compliance inside and out.
Transparent Pricing: No hidden fees. Your ROI is crystal clear.
Scalable Solution: Whether you’re a small self-insured employer or a national payer, our platform grows with you.

Next Steps: Elevate Your Claims Auditing

Ready for an audit upgrade? Think of Avelis Health like upgrading from standard definition to 4K: brighter, sharper, and more detailed.

The big question: Are you content with chasing down errors manually? Or do you want a future where every dollar counts?

Let’s start your journey to flawless healthcare reimbursement accuracy.

Learn more and book a demo with Avelis Health today!

Disclaimer: This post is for informational purposes. All names and figures are based on client case studies and publicly available data.