Payment & directory accuracy for health plans and TPAs
Every claim priced right. Every provider record you can trust.
Kestrel prices every claim to the contract you signed and matches it to the right provider. Dragonfly PDM keeps your provider data clean at the source. Every answer shows its work.
Built for Medicare Advantage, Medicaid MCOs, commercial plans, TPAs and ASOs, self-funded employers, and reference-based pricing programs.
A pended claim costs more than 20× a clean one.
Every claim that stops for a person costs about $20 to finish. One that sails through costs well under a dollar. You're paying the difference every day.
Source: Healthcare Finance News.
Slide the numbers to yours.
Vendor says 90%+? Ask what they're counting.
Kestrel goes after both. Let's find out how much of it is yours.
Each stands on its own. Together, they close the loop.
Kestrel · Claims pricing engine
Claims priced the way your contracts are written.
Kestrel matches every claim to the right provider and prices it to the agreement you signed, line by line, with the math attached. It runs beside your core system. No rip-and-replace.
Explore Kestrel →Dragonfly PDM · Provider data for claims systems
Provider data your claims system can actually use.
Every roster, every source, turned into one record per provider and one address per real location. Loads and validates a roster in days. Learns from your in-house data sources.
Explore Dragonfly PDM →Got a contract that pays three points more on Tuesdays during a full moon? We don't support that today. But if you actually signed it, we'll make it happen.
Dave Medlock · Founder, Maven One HealthEvery answer explains itself.
Every priced line carries its own note: the contract term it matched, the Medicare rates it used, the modifiers it applied, and the rule that set the allowed amount. Your analyst reads it. Nobody reverse-engineers anything.
Claims show where your providers actually practice.
When a provider bills for a visit, the claim records where it happened. That makes your paid claims a running record of where each provider really sees patients.
In our directory work, listings backed by claims at that address were confirmed correct 88% of the time. Listings with no claims there: only 29%.
Dragonfly PDM uses that evidence to show which listings you can trust and which to check first.
One podiatrist. Two offices. Ten months of claims.
Days seen at each office, by weekday. The directory lists one address and no hours.
See it on your own claims.
Send us a contract and a sample of claims. We'll price them, match them, and walk you through every line, including the ones your current system got wrong - and why.