ClaimInSight is AMPS’ modern solution for prepay claim editing and physician-led high-dollar bill review—engineered to help health plans navigate the complex financial and operational challenges of 2025. As healthcare costs rise and margins tighten, ClaimInSight delivers real, measurable savings through clear, defensible processes—without the inefficiencies, opacity, or friction of outdated cost containment tools.
ClaimInsight is AMPS’ comprehensive payment integrity suite, comprised of two purpose-built tools:
• Intelligent Payment Utility (IPU): a transparent, rules-based prepay editing platform
• High-Dollar Review (HDR): a physician-only review process for large, complex claims
Together, they offer scalable, defensible cost containment—yet each can deliver immediate value on its own.
Our Intelligent Payment Utility (IPU) is designed to identify and correct overpayments before they happen—using a transparent, rules-based process that offers full visibility into how and why every edit is applied. With predictable PMPM pricing and no contingency fees, IPU helps protect your ROI while delivering clear, defensible savings.
• Easily auditable workflows for financial and compliance assurance
• Supports accurate budgeting, margin protection, and consistent savings
• Delivers results without disrupting provider relationships
ClaimInSight takes high-dollar bill review to the next level. Unlike vendors who rely on nurses or algorithms, we use only U.S. board-certified physicians to manually review complex claims—ensuring unmatched clinical accuracy and defensibility. Our physician-led approach catches errors that others miss, such as a Level 4 E&M code billed with only Level 3 documentation, and helps reduce costly overpayments that routinely bypass automated systems. Implementation is fast and seamless—no IT lift, no complex integrations.
• Every claim is reviewed by a physician—not a nurse or software
• Generates $7M–$9M in annual savings per 500,000 covered lives on average
• Just send us the UB and itemized bill—we’ll take it from there
Built for Today’s Claims Environment
ClaimInSight isn't just another tool—it’s a smarter, clearer path to sustainable cost containment and smarter healthcare economics.
ClaimInsight offers more than savings—it offers clarity, control, and confidence.
Tell us a bit about yourself, and we’ll connect you with a ClaimInsight expert.
