LBS Payment Integrity Platform for Health Plans and TPAs

Lifetime Benefit Solutions Payment Integrity Platform is a SaaS solution that centralizes post-payment audit workflows, prioritizes recovery opportunities using AI, and delivers transparent reporting to help health plans, TPAs, and carriers recover more dollars faster.

Organizations using LBS have achieved measurable outcomes:

• $794 million in total client savings over six years for a large regional payer, with annual savings growing from $96 million to $166 million (approximately $27 PMPY)
• $8.6 million recovered during the first year for a New York-based regional plan through a focused post-payment audit program
• More than $4.5 million generated across five targeted audit categories for a northeast regional payer

The platform replaces fragmented audit processes with a governed, structured environment where every step is standardized, every decision is documented, and every outcome is easy to review.

Key capabilities include:

• Post-payment audit engine - Identify overpayments and recovery opportunities without disrupting adjudication
• AI-driven prioritization - Focus resources on claims with the highest recovery potential using explainable recommendations
• Rapid concept deployment - Create and launch new audit concepts quickly to address emerging risks and contain leakage sooner
• Guided workflows and reporting - Standardize reviews and maintain visibility across the recovery lifecycle
• Exploratory audits (concept testing) - Test suspected risks and evaluate recovery potential before committing full resources

Leakage can appear anywhere in the claims process. The platform combines broad audit coverage with configurable logic across areas including coordination of benefits (COB), retroactive termination, duplicate payments, contractual overpayments, predictive data mining, DRG validation and readmissions, and custom audits.

• You stay in control - The platform flags, prioritizes, and explains. Your team makes the decisions.
• Rapid concept deployment reduces time to value by helping teams create, test, and launch new audit concepts quickly
• Centralized operations reduce fragmentation and standardize workflows, reporting, and evidence management across vendors and teams
• Provider-friendly recovery with a no auto-deny approach and documented audit findings supporting accurate recoveries
• Full transparency through documented decisions, audit trails, and reporting that support leadership visibility and governance

The platform supports HIPAA-aligned security and privacy requirements. Built on AWS and Databricks infrastructure with secure data-transfer processes, authentication controls, and Single Sign-On (SSO) capabilities designed for payer environments.

The solution is claims-platform agnostic and supports secure ingestion through standardized data files and enterprise data warehouse feeds. The data model includes claim header, claim detail, member eligibility, provider, coordination-of-benefits, and product information. LBS has experience supporting Facets-originated data, and compatibility with other platforms is evaluated during implementation through data mapping and validation. Data can be exchanged via Amazon S3 and secure transfer protocols.

Lifetime Benefit Solutions Payment Integrity is offered through an annual SaaS subscription based on covered-member volume using a PMPM-equivalent pricing structure. Implementation and data-onboarding requirements are scoped during contracting. Customer-specific terms may be delivered through an AWS Marketplace private offer.

Eligible prospects may participate in a controlled proof of concept that evaluates data compatibility and preliminary payment integrity opportunity. The analysis is analyst-validated and may produce candidate claims, preliminary opportunity estimates, and identification of missing data fields.

Each customer receives a designated implementation lead. During onboarding, data mapping and validation confirm compatibility with your claims environment. Implementation costs are embedded into the first-year contract based on plan-specific requirements.