Fraud Solutions Index

NHCAA’s Platinum, Premier and Standard Supporting Members are leading providers of products & services to the health care anti-fraud industry, are valued partners who support our mission, and have demonstrated outstanding commitment to the fight against health care fraud. 

Click here to download NHCAA’s Platinum Supporting Member Anti-Fraud Solutions Guide.


Alivia Analytics

400 TradeCenter, Suite 5900
Woburn, MA 01801

Phone: 617-227-5111

Alivia Analytics is the industry leader providing solutions that are revolutionizing healthcare payment integrity. Boasting the lowest false positive rates in the industry, Alivia Analytics delivers unprecedented speed, accuracy and usability. Integrated case management, user-friendly dashboards, simple data ingestion and flexible workflows put new power in the customers’ hands. By designing technology that adapts to existing business processes, healthcare payers can rapidly generate more confident outcomes and realize greater ROI. Let’s achieve healthcare payment integrity, finally.

Change Healthcare

3055 Lebanon Pike
Nashville, TN 37214

Phone: 615.932.3000

Change Healthcare is a leading provider of software and analytics, network solutions and technology-enabled services all designed to enable smarter healthcare. By leveraging our Intelligent Healthcare Network™ the single largest financial and administrative network in the United States healthcare system – payers, providers and pharmacies are able to improve efficiency, reduce costs, increase cash flow and more effectively manage complex workflows. Learn more at


2405 Commerce Ave NW, Suite 500
Duluth, GA 30096

Phone: 470-223-3592

Codoxo’s mission is to make healthcare more affordable and effective for everyone and serves as the premier provider of artificial intelligence-driven solutions and services that help healthcare companies and agencies proactively detect and reduce risks from fraud, waste, and abuse and ensure payment integrity. Codoxo’s Unified Cost Containment Platform helps clients manage costs across network management, clinical care, provider coding and billing, payment integrity, and special investigation units. Our software-as-a-service applications are built on our proven Forensic AI Engine, which uses patented AI-based technology to identify problems and suspicious behavior far faster and earlier than traditional techniques. Our solutions are HIPAA- compliant and operate in a HITRUST-certified environment. For additional information, visit


10701 S River Front Pkwy
Unit 200
South Jordan, UT 84095
Phone: (770) 379-2800

Payment integrity leadership requires experience, scalability, innovation, and proven value. Cotiviti has spent 20+ years honing our solutions specifically to drive exceptional value for our clients all along the claim payment life cycle — from prospective payment policy management and clinical coding review to both pre and postpay chart review and fraud investigation. We help clients work more effectively across their payment accuracy silos by deploying the right approach at the right time, driven by a full-service model and the deepest industry expertise.

EXL Health

320 Park Avenue
29th Floor
New York, NY 10022
Phone: 212.277.7100

EXL Health combines deep domain expertise with analytic insights and technology-enabled services to transform how care is delivered, managed, and paid. Applying our expertise in AI, analytics and cloud, we make sense of your health-related data, enabling you to improve outcomes, optimize revenue, and maximize profitability across the care continuum. Our digital dexterity and Human Ingenuity are the catalysts to solve complex healthcare problems. With data on more than 260 million lives, we work with hundreds of organizations across the healthcare ecosystem. EXL’s proprietary Payment Services analytics platform and digital first analytics support our clients in maximizing reimbursement and ensuring payment integrity. To learn more visit

Healthcare Fraud Shield

16052 Swingley Ridge Road
Suite 200
Chesterfield, MO 63017
Phone: 888.333.8140

Healthcare Fraud Shield was founded in 2011 to offer innovative fraud, waste, and abuse (FWA) solutions to the healthcare insurance industry. The focus of Healthcare Fraud Shield is solely on healthcare fraud prevention and payment integrity with a successful approach based on many unique advantages we deliver to our clients.

Healthcare Fraud Shield’s fraud, waste, and abuse software as a service platform – FWAShield – is an integrated solution consisting of PreShield (pre-payment), AIShield (AI), PostShield (post-payment), RxShield (pharmacy analytics), QueryShield (ad hoc query and reporting tool) and CaseShield (case management).

FWAShield was developed by industry leading healthcare subject matter experts with the latest technology available today to provide the most affordable, flexible, transparent, efficient, and effective solution in the marketplace.

MedReview Inc.

199 Water Street, 27th Floor, New York, NY 10038
Phone: 734-262-0242

“Physician Approved Payment Integrity” makes MedReview a different type of payment integrity firm. Our doctors review, approve and document every claim we reassign providing our clients with the lowest appeal overturn rate in the industry. This focus on clinical quality returns the highest savings per review.

MedReview delivers Pre-Payment and Post-Payment DRG, Hospital Bill Audit, and Readmission reviews and audits. As a part of the solution, our proprietary selection algorithm delivers a targeted selection resulting in a 40% or greater reassignment rate. MedReview is proud to work with three (3) of the top five (5) largest health plans in the US.


115 Fifth Avenue
New York, NY 10003
Phone: 866.750.7427

MultiPlan offers a total healthcare cost containment solution that includes payment integrity, network-based and analytics-based services, helping payers reduce the cost of care and improve competitiveness. Unlike similar products, MultiPlan’s payment integrity services include a personal review by an experienced clinician in addition to automated reviews. This human touch allows us to catch more complex issues indicative of waste and abuse, that go undetected by other products. For 40 years, we’ve processed claims prepayment. Today more than 1 million providers participate in our networks, partnering with us to control claim costs. This rich history helps us resolve medical and dental payment integrity issues quickly while minimizing provider abrasion – all before our clients pay a dime.


11000 Optum Circle
Eden Prairie, MN 55344
Phone: 800.765.6807


At Optum, we are a leading health services innovation company dedicated to helping make the health system work better for everyone. We create simple, effective and comprehensive solutions for organizations and consumers across the whole health system by integrating our foundational competencies of consumer experience, clinical expertise, data and analytics, and embedded technology into all Optum services. By understanding the needs of our customers, members and patients and putting them at the center of everything we do, we will achieve our aspiration of improving experiences and outcomes for everyone we serve while reducing the total cost of care.


100 SAS Campus Dr
Cary, NC 27513
Phone: 919.677.8000

SAS is the leader in advanced analytics software and services, and the largest independent vendor in the business intelligence market. With SAS® payment integrity solutions, health care organizations can detect suspicious activity, prevent improper payments, and uncover collusion and multiparty fraud schemes. Since 1976, SAS has given customers around the world THE POWER TO KNOW®.

Shift Technology

321 Summer Street, 7th Floor
Boston, MA 02210
Phone: 817-456-9229

Shift Technology delivers AI decisioning solutions to benefit the global insurance industry and its customers. Our products enable insurers to automate and optimize decisions from underwriting to claims, resulting in superior customer experiences, increased operational efficiency, and reduced costs. The future of insurance starts with Decisions Made Better. Learn more at



Affiliated Monitors, Inc.

P.O. Box 961791
Boston MA 02196
Phone: 866-201-0903


Affiliated Monitors, Inc. (AMI) – provides independent integrity monitoring and IRO services in healthcare and other industries. Since 2004, health regulatory authorities in most states, including state Attorneys General Medicaid Fraud Offices, State Departments of Health, and the HHS Office of Inspector General, have trusted AMI to successfully monitor more than 800 matters involving hospitals, healthcare providers, surgical centers, skilled nursing facilities, home health agencies, diagnostic laboratories and many others. AMI’s monitoring services are being used with greater frequency by insurance networks to oversee the implementation of corrective action plans by providers. One significant benefit of AMI’s services is that the monitoring costs are paid for by the individual or entity being monitored. AMI also provides proactive assessments of corporate compliance programs and compliance and ethics culture. Our approach is practical and remedial: we recommend improvements, share best practices, and help remediate areas of concern. AMI’s monitoring provides healthcare organizations with guidance needed to achieve and demonstrate sustainable compliance.


500 North State College Blvd
Suite 900
Orange, CA 92868
Phone: 610.727.7000


AmerisourceBergen is a leading global healthcare solutions company. The company drives innovative partnerships with pharmacies, health systems, practices and manufacturers to improve product access, increase supply chain efficiency and enhance patient care. Customers count on AmerisourceBergen for comprehensive services and solutions across the healthcare supply chain – from commercialization and distribution to pharmacy, health system, practice and manufacturer solutions. The company’s extensive knowledge, global reach and innovative partnership philosophy enable them to help customers capitalize on the dynamic changes in healthcare. With more than $120 billion in annualized revenue, AmerisourceBergen is the leader in global sourcing and distribution and employs approximately 16,000 employees worldwide from their headquarters in Conshohocken, PA. AmerisourceBergen. Where knowledge, reach and partnership shape healthcare delivery. For more information, visit

CGI Federal Inc.

1001 Lakeside Avenue
Suite 800
Cleveland, Ohio 44114-1151
Phone: 410.279.0996


CGI, a global IT and consulting company, is an industry leader in identifying improper payments and assisting healthcare payers to control costs. Our fraud, waste and abuse solution, ProperPay, includes data mining functionality, algorithms and edits to identify improper payments and other features that increase efficiencies in the audit and recovery process.


710 Johnnie Dodds Blvd Suite 100
Mt Pleasant SC 20464
Phone: 866.225.6447

ClaimLogiq is a healthcare software and technology company that delivers a proactive approach to payment integrity through a powerful, simplified solution. The unique payer-facing, claim-analyzing solution is HITRUST CSF® certified and makes claims accessible to all size healthcare payers for in-depth insight and real-time access into the status of every claim at every stage of the audit lifecycle for controlled, consistent, accurate, and defensible outcomes, second to none. ClaimLogiq’s innovative software stands out from the crowd by allowing payers client-driven control, customizability, and total transparency over the entire claim process and can be applied as a SaaS model, full services, or as a hybrid to suit the specific needs of every payer and provider agreement. ClaimLogiq’s groundbreaking technology produces more cost savings and all-but-removed provider abrasion, impacting millions of lives annually in the pursuit of a higher quality of healthcare for all. For more information, visit or follow ClaimLogiq on LinkedIn.


301 Plus Park Blvd Ste 210
Nashville, TN 37217-1036


ClarisHealth is the answer to the health plan industry’s siloed solutions and traditional models for identification and overpayment recovery services. We provide health plans and payers with total visibility into cost containment operations through our one-of-a-kind advanced technology platform Pareo®. The Pareo Fraud solution is an A.I.-powered web-based platform for investigators, SIU leaders and other areas of a healthcare payer’s Payment Integrity operation to detect, create, manage, process and report on leads and cases that are potential fraud, waste, abuse and general overpayments. The solution easily integrates with ClarisHealth’s Total Payment Integrity solution suite. As a standalone offering, Pareo Fraud helps SIUs and its investigators become more efficient in their day-to-day activities, better monitor the success and ROI of the unit, and improve the decisioning time for improved recoveries.

Coalition Against Insurance Fraud

1012 14th Street, NW Suite 1105
Washington, DC 20005
Phone: 202-393-7330

Founded in 1993, the Coalition Against Insurance Fraud is a nonprofit alliance of consumer groups, insurance companies, government agencies and other partners combating all forms of insurance fraud through advocacy, public education and research. The Coalition has more than 210 member organizations.

Context 4 Healthcare, Inc.

55 Shuman Blvd., Ste 650
Naperville, IL 60563
Phone: 800-783-3378

Context 4 Healthcare is the leading provider of cloud-based healthcare compliance solutions in verifying medical claim accuracy for health plans and benefits administrators. These solutions are designed to review for complex coding accuracy, identification of potential fraud, waste, and abuse (FWA) situations before the claim is paid, and to review for potential FWA situations in claim history. Context’s Medical Director and our team of certified claim experts maintain solution rules weekly for up-to-date compliance and identification of potential new FWA schemes. The semi-annual creation of our proprietary UCR fee schedules is also a source for identifying potential FWA situations leading to new solution rules, a capability unique to Context. Our experts also blog for your benefit, letting you know about emerging situations that may affect your compliance, and what Context is doing about it. Since 1988, Context has been the healthcare industry’s leading compliance specialist.


2000 Purchase Street
Purchase, NY 10577-2509
Phone: 914.249.2509

Mastercard Healthcare Solutions provides a proven AI solution that differentiates by leveraging its experience in payment fraud to complement claim fraud mitigation. Mastercard Healthcare Solutions’ unique competency supports post-pay detection, while also creating prospective (pre-pay) models built by identifying anomalies found in historical claims data (post-pay). In this webinar, you will learn how you can increase detection of fraud, waste and abuse (FWA) before sending good money for bad claims, significantly reducing inefficient pay-and-chase activities while moving toward a prevent and save business model. With increased detection of true FWA, false positives are greatly reduced, anomaly detection is significantly increased, and payers can focus their investigators’ time on highly-likely FWA.


202 Burlington Rd
Bedford, MA 01730-1407
Phone: 781.271.2000

MITRE is a not-for-profit organization that operates research and development centers sponsored by the federal government.

We operate FFRDCs-federally funded research and development centers-which are unique organizations that assist the United States government with:

  • Scientific research and analysis
  • Development and acquisition
  • Systems engineering and integration

We also have an independent research program that explores new and expanded uses of technologies to solve our sponsors’ problems.

MITRE’s Sole Focus Is to Operate FFRDCs

MITRE is chartered to work in the public interest. We have no commercial interests. We have no owners or shareholders, and we can’t compete for anything except the right to operate FFRDCs. This lack of commercial conflicts of interest forms the basis for our objectivity. We also have the ability to acquire sensitive and proprietary information from the government and industry to inform our work. These organizations are able and willing to share data because they know we won’t use it for a competitive advantage.

Moreover, because we operate multiple FFRDCs, we foster a culture of knowledge sharing. We apply what we learn from addressing one sponsor’s challenges to similar issues faced by other federal agencies. This means when sponsors engage with us, they have access to all the minds of MITRE.

Verisys® Corporation

1001 N. Fairfax Ave
Suite 640
Alexandria, VA 22314
Phone: 888.837.4797


Verisys® provides health care compliance professionals with the tools they need to prevent waste, abuse, and fraud committed by high-risk people, professionals, and businesses. We are the leading provider of sanctions, exclusions, and disciplinary actions. Our flagship product, FACIS®, offers a full complement of primary sources to monitor licensure, DEA, criminal, sex offender, abuse registries, and more.

Member Benefits

NHCAA offers membership categories for health insurers, governmental entities, and other companies and organizations that support the NHCAA Mission, as well as individuals, who want to join us in the fight against health care fraud.