Penstock Group, a leader in healthcare payment integrity, has announced a partnership with Paradigm, an accountable specialty care management organization and developer of a proprietary payment integrity program. The partnership aims to enhance claim accuracy in the area of surgical implants by integrating Paradigm’s robust expertise into Penstock’s programs.
Paradigm has been a pioneer in value-based care for over 30 years, and Penstock has quickly established a reputation for finding niches in the payment integrity space. The partnership combines Paradigm’s expertise in surgical implant accuracy and Penstock’s culture of innovation to provide full transparency and payment accuracy.
The partnership will include a seamless integration with ClearBridge, Penstock’s comprehensive SaaS payment integrity solution. ClearBridge optimizes workflow, offers seamless self-service for auditors, and negates the need for constant IT assistance, including intuitive search, advanced reporting, and agile edit development.
Paradigm’s comprehensive Implant Savings Program identifies savings opportunities through expert bill review and industry-specific data, ensuring accuracy in surgical implant claims. The program delivers an average savings of 69% for payers. Paradigm specializes in reviewing charges for surgical implants, with over 200,000 cases reviewed to date. Their surgical implant review experts, in tandem with a proprietary database, generate savings that far exceed those found using typical surgical claim review approaches, reducing unnecessary spend in healthcare.
Ninety-eight percent of surgical implant cost savings identified by Paradigm are upheld after any appeal, and 88% of total bills remain undisputed. The partnership brings together two industry leaders committed to addressing core cost challenges in the industry and creating sustainable solutions.
Penstock is a service partner and SaaS builder for forward-thinking health plans, empowering recovery, audit, and regulatory teams to achieve accuracy from the start. With payment integrity and regulatory technology and services, Penstock removes inefficiencies, costly errors, and wasteful spending, ultimately lowering healthcare costs for payer organizations and their members.
Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the best outcomes for patients, payers, and providers. Deep clinical expertise is the foundation for every part of Paradigm’s business, including risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment integrity programs.
