The unified organization combines SourcEdge’s claims system technology optimization expertise with Alivia’s AI-powered payment integrity / FWA data and analytics platform
BOSTON and PHILADELPHIA (February 27, 2024) – Alivia, a leading AI-based healthcare payment integrity platform for fraud, waste, and abuse (FWA) has acquired SourcEdge, a national provider of claims systems modernization services serving over 25 health plans. Together, the capabilities empower healthcare payers with an end-to-end claims solution.
Alivia and SourcEdge have been working collaboratively for more than two years, resulting in a solution that combines expert professional services with purpose-built healthcare technology. The combined entity will operate under the Alivia brand.
“Our platform and its modules are even more effective when our clients’ claims and business systems are optimized to achieve financial and operational returns, says Michael Taylor, MD, Alivia CEO. “We are thrilled to incorporate this exceptional, well-respected team of experts we know and trust.”
SourcEdge brings unique expertise to assist health plan CIOs and VPs modernize and maintain their critical healthcare claim systems. This includes protected health information (PHI) security, value-based care strategy accelerators, and claims payment data consolidation.
“Alivia’s SaaS platform combined with SourcEdge’s data transformation services provides a unique combination for end-to-end claims management,” adds Mark McAdoo, SourcEdge CEO who will become President of Alivia and member of the Board of Directors. “Combining products and services demonstrates the efficiency of modern healthcare technology and digital transformation.”
Fusing these capabilities also includes the formation of a tech-enabled services practice that uses the platform to provide outsourced SIU / investigative resources, pre-pay clinical reviews, post-pay recovery audits, and end-stage renal disease (ESRD) premium protection.
Bill Lucia, former Chairman, President & CEO of HMS (NASDAQ: HMSY) and Alivia Board Member comments, “Finding solutions to improve the effectiveness of our nation’s healthcare system will continue to dominate headlines and remain top-of-mind for policymakers and regulators. Embracing technologies that truly unlock this potential through use of advanced artificial intelligence are critical tools in addressing healthcare challenges and will improve affordability and change the status quo for patients, providers, and payors.”
Healthcare-focused private equity firms Council Capital and Health Enterprise Partners (“HEP”) provided financing for the transaction.
The financial details of the transaction were not made public.
About SourcEdge
SourcEdge Solutions, LLC (known as SourcEdge) is a trusted technology solutions partner helping health plan CIOs and VPs modernize and maintain their claims and business systems. This unique expertise includes protected health information (PHI) security, value-based care strategy accelerators, and claims payment data consolidation. We help our clients achieve financial and operational returns by working closely with world-class software, database, and cloud providers. Our talented people bring the most modern tools and proven best practices to each project to help health plans efficiently serve their members, patients, and providers.
About Alivia
Alivia Analytics, LLC (known as Alivia) provides a revolutionary, AI-powered payment integrity platform for cost containment serving commercial and government health plans as well as auditors and fraud investigators. The platform offers speed, accuracy, and adaptability with powerful data and analytics. It includes a pre-pay accuracy module to prevent improper payments, Alivia FWA Finder™ for post-pay fraud detection and recovery, and Alivia Case Manager™ that works seamlessly with our modules or can be independently used with any system. Our tech-enabled services leverage the platform to provide outsourced SIU / investigative resources, pre-pay clinical reviews, post-pay recovery audits, and ESRD premium protection.