Anomaly Insights today announced the launch of Manage, a new solution built specifically for managed care executives. For decades, payers have used sophisticated data-driven systems to evaluate, deny, and adjudicate claims, while the system’s complexity made it nearly impossible for providers to see what is actually happening on the other side of the transaction. Health systems have not had the tools to keep up, often trying to address a machine scale problem by pushing back on payers with anecdotes or hiring expensive consultants. Anomaly built Manage as the AI engine for managed care to change that dynamic, and give providers the ability to push back.
Manage examines every claim across every payer a health system contracts with, identifying patterns and synthesizing complex data from contracts, rate schedules, claims, and remits all within the same model on the Anomaly platform. The solution shows providers exactly when each of their payers is denying claims they should be paying based on contract terms, downcoding services to lower-reimbursement codes, requesting excessive medical records to delay payment, or clawing back funds after a claim was paid. Too often, providers negotiate a rate increase only to see their payers increase denials and take backs significantly. This has become a common strategy from payers, which providers have lacked the insight to address. Now, Manage shows providers how payers compare to their peers, how much these tactics are costing the provider, and delivers documented, claim-level evidence for provider organizations to bring to contract negotiations.
The average commercial payer deploys multiple AI and analytics vendors specifically to find new methods and reasons to pay providers less. Providers entered billion-dollar contract negotiations armed only with anecdotes from revenue cycle teams and high-level reports that may reveal aspects of the problem without explaining or fully documenting it. The asymmetry has compounded with every contract cycle, but Anomaly’s platform finally gives providers the ability to come to the negotiating table with the leverage they need and deserve.
Manage is the fourth solution on the Anomaly platform, building on existing capabilities: Detect, Predict, and Recover. Anomaly’s proprietary platform, built on insights from over 3 billion claims now supports both revenue cycle operations and managed care teams, identifying payer policy changes as they emerge, predicting denials before claims are submitted, and prioritizing the highest-value recovery opportunities. Manage extends the same underlying intelligence to every claim processed by the platform, sharpening behavioral intelligence that finally gives provider organization the leverage to enter conversations with their payers with the structured information to effectively change payer behavior. For the first time, revenue cycle and managed care teams can act on the same underlying intelligence to both improve daily operations, and long-term relationships with payers.
“Our payment system in healthcare is hard enough without having to battle active antagonists like insurance companies and their vendors. Managed care executives constantly battle payers that know more about them than they know about themselves,” said Mike Desjadon, CEO of Anomaly. “Manage closes that gap. It gives our customers a systematic, comprehensive view of where each payer is deviating from what was contracted, where the outlier claims and denial patterns compare to their peers, and what to do about it. Anecdotes do not change payer behavior, evidence does – and it’s working.”
In an early deployment with a major U.S. health system, Manage identified two payer behavior patterns representing more than $110 million in annual financial impact, including a single payer denying chemotherapy and immunotherapy claims at more than five times the rate of its peers. When the health system brought the documented evidence to the payer, the payer agreed to a settlement while the underlying issue was resolved. Manage is designed to support managed care directors, VPs of payer contracting, and the CFOs and COOs who oversee strategic payer relationships.
About Anomaly
Anomaly is the first AI-powered payer intelligence company, built to close the data gap between payers and the providers they contract with. By analyzing billions of healthcare transactions in real time, Anomaly’s platform decodes payer behavior at machine speed and precision, surfacing exactly where each payer is denying, downcoding, delaying, and clawing back money, and giving providers the benchmarked evidence to push back. Anomaly has recovered tens of millions of dollars in provider revenue and produced measurable changes in payer behavior at the negotiating table.
The platform operates across four capabilities: Detect, Predict, Recover, and Manage. Anomaly works with health systems, large provider organizations, diagnostic laboratories, and outsourced RCM companies across the country. Founded in 2020 and headquartered in New York, Anomaly is backed by Sound Ventures, RRE Ventures, Madrona, and Redesign Health. Learn more at findanomaly.com.
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