Pamastay unifies claims data from multiple sources into actionable intelligence for compliance, FW&A detection, and financial risk management.
Purpose-built detection logic for healthcare, not generic anomaly algorithms.
Surface claims that lack expected clinical context or supporting documentation for investigator review.
Flag claims that exceed expected utilization thresholds based on CMS guidelines and medical policy.
Identify providers billing significantly above specialty and peer group averages with configurable thresholds.
Highlight unusual coding patterns across your network for compliance review and education opportunities.
Identify potential duplicate claims across your network for review and resolution.
Adjust detection thresholds and configure organization-specific outlier parameters to match your compliance priorities.
Identify when patients are receiving care outside your network, eroding your ability to manage costs and coordinate care effectively.
One schema, multiple data feeds. Process CCLF, EDI 837, and direct payer feeds without manual transformation.
Native support for CMS Claim and Claim Line Feed files. Automated parsing of all CCLF file types with validation and error handling.
Process professional (837P) and institutional (837I) claims from any payer. Automatic segment parsing and data normalization.
Automated quality checks, duplicate detection, and data integrity validation on every file load.
Maximize risk adjustment accuracy while minimizing audit exposure.
Identify suspected conditions based on claims patterns. Flag members with undocumented HCCs that impact RAF scores.
Projected risk scores based on current documentation with gap analysis showing revenue impact of each missing HCC.
Identify which HCCs and providers are most likely to be sampled and which would fail documentation review.
Annual Wellness Visit completion tracking with member-level worklists for care coordinators.
Understand provider behavior across your entire network.
Individual dashboards showing coding accuracy, referral patterns, utilization metrics, and compliance indicators.
Compare providers against specialty-specific, geographic, and patient-mix-adjusted benchmarks.
Map referral relationships across your network. Identify leakage, outlier patterns, and optimization opportunities.
Aggregate views of network performance by region, specialty, contract type, and custom groupings.
One unified schema for all your claims data.
All CCLF file types for Medicare ACOs
Professional and institutional claims
CSV, Excel, and custom formats
Built for healthcare data from day one.
Full HIPAA compliance with BAA execution
Certified security controls and processes
End-to-end encryption for data at rest and in transit
Secure cloud infrastructure with 99.9% uptime
Maximize risk adjustment accuracy while minimizing audit exposure.
Identify suspected conditions based on claims patterns. Flag members with undocumented HCCs that impact RAF scores.
Projected risk scores based on current documentation with gap analysis showing revenue impact of each missing HCC.
Identify which HCCs and providers are most likely to be sampled and which would fail documentation review.
Annual Wellness Visit completion tracking with member-level worklists for care coordinators.
Book a demo to see how these features work with your data.