Performant Announces Recently Launched Medicare Advantage Offering Exceeds Four Million Contracted Lives

Rhea-AI Summary

Performant Financial Corporation (Nasdaq:PFMT) has secured contracts covering over four million lives for its new Premium Accuracy service, aimed at improving Medicare Advantage Plans by addressing inaccuracies in primary health coverage data. This service allows MA Plans to restore up to 80% of premium payments that could be lost due to incorrect records. The company identified over $2M in premium recoveries within two months of launching this initiative, highlighting its potential to enhance revenue for MA providers while improving operational efficiency.

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• Secured contracts covering over four million lives for the Premium Accuracy offering.
• Identified over $2M in recoverable premiums for a national MA Plan within two months.
• Provides detailed reporting data that enhances multiple areas of MA plan operations.

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• None.

LIVERMORE, Calif.--(BUSINESS WIRE)--Performant Financial Corporation (Nasdaq:PFMT), (“the Company”), a provider of technology-enabled recovery and related analytics services, today announced that it has contracted over four million lives for its recently launched Premium Accuracy offering, a Medicare Secondary Payer (MSP) service for Medicare Advantage Plans.

Medicare Advantage (MA) is the fastest-growing segment of private Health insurance with 8% enrollment growth per year. When MA enrollees have access to primary health coverage outside of Medicare (such as an employer group health plan), the Centers for Medicare and Medicaid Services (CMS) reduces the premium payment to the MA Plan by 80% or more. Yet, industry data on such other coverage is often inaccurate, causing CMS to record the member as possessing other primary coverage, when that coverage may be expired or might have never existed. As a result, MA Plans often receive greatly reduced premium payments on members for whom they are bearing the primary medical expense.

“Our Premium Accuracy offering is yet another example of our aggressive expansion in the Healthcare space, and our drive to be the leading Healthcare payment integrity provider,” stated Simeon Kohl, Vice President and General Manager of Healthcare for Performant. “The identification of other insurance coverage and the application of primacy rules is complex, with large dollars at risk. In fact, within the first two months of implementing a national MA Plan, we successfully identified over $2M in premiums to be restored. Payers are looking towards trusted partners, like Performant, to ensure they are receiving the most accurate premiums for their Medicare Advantage population.”

Through its new Premium Accuracy Offering, the Company leverages its proprietary technology to identify these data inaccuracies and then provides resolution through updating CMS records via its proven workflows. For each correction affected by Performant, the MA Plan can obtain restored premium payments for every month the premium was incorrectly reduced.

In addition to restoring the premium payments, Performant’s Premium Accuracy Offering is holistic and provides detailed reporting data that can improve multiple areas of MA plan operations. These include, improved member management, expanded coordination of benefits, improper payment collection and risk factor analysis

“Unlike other vendors in the MA premium integrity market, Performant evidences an exceptionally high level of partnership with clients, providing full transparency into inventories and pending cases. This data gives payers actionable insights across their entire MA operation. Every payer plan is unique, and we believe that collaborative partnerships are the right way to help all of our stakeholders achieve their goals,” stated Aaron Seator, Division Vice President TPL Services for Performant.

About Performant Financial Corporation

Performant helps government and commercial organizations enhance revenue and contain costs by preventing, identifying and recovering waste, improper payments and defaulted assets. Performant is a leading provider of these services in several industries, including healthcare, student loans and government. Performant has been providing recovery audit services for over ten years to both commercial and government clients, including serving as a Recovery Auditor for the Centers for Medicare and Medicaid Services.

Powered by a proprietary analytic platform and workflow technology, Performant also provides professional services related to the recovery effort, including reporting capabilities, support services, customer care and stakeholder training programs meant to mitigate future instances of improper payments. Founded in 1976, Performant is headquartered in Livermore, California.