Abacus Insights and CoverSelf Partner to Strengthen Payment Integrity for U.S. Health Plans

As Cost Pressures Mount, Health Plans Now Have a More Holistic Option for Payment Integrity

BOSTON & SAN FRANCISCO--(BUSINESS WIRE)--Abacus Insights, a leading healthcare data usability platform, and CoverSelf, a cloud-native payment integrity (PI) platform purpose-built for U.S. health plans, have announced a strategic integration that brings together configurable pre- and post-pay editing with a trusted data foundation.

Through the CoverSelf SmartEdit™ and CodeSense™ solutions, health plans gain the orchestration, transparency, and self-service control to act on PI opportunities. The capabilities are now enhanced by Abacus Insights' structured and unstructured data assets, including claims history, clinical records, and longitudinal member information. This creates a single, governed environment that surfaces cost containment opportunities earlier in the claims lifecycle.

Health plans face mounting pressure to reduce improper payments across Commercial, Medicare Advantage, and Medicaid lines, and so are demanding greater visibility into how their PI models perform. By pairing CoverSelf's configurable editing engine with Abacus Insights' enterprise-grade data platform, payers can move PI earlier in the claims lifecycle, catching billing anomalies, coding patterns, and clinical inconsistencies before payment, without sacrificing data richness and platform control.

The combined capability supports a proactive, in-house PI strategy where every rule is visible, every result is auditable, and the data foundation grows with the plan's needs.

“Payment integrity is only as effective as the data foundation behind it,” said Minal Patel, Chief Executive Officer at Abacus Insights. “By uniting enterprise grade data usability with configurable orchestration and full transparency, we are helping payers future-proof their payment integrity strategy and deliver greater ROI with measurable outcomes.”

With a full longitudinal view of each member, PI and finance teams can detect coding and billing patterns across providers and AI-driven workflows. They can compare providers by specialty, geography, and case mix; detect concentrated or compressed high paying codes; and spot low coding variation or persistent diagnoses across visits when treatment hasn't changed.

The CoverSelf platform will leverage Abacus Insights' HITRUST-certified data environment, giving payers a governed, secure data pipeline without the burden of managing integration infrastructure. Plans can run pre-pay and post-pay workflows in a single, governed instance, reducing data wrangling and increasing operational control.

“Health plans come to CoverSelf for payment integrity intelligence, savings, and control. Through this partnership, Abacus Insights removes real friction from how payer data is governed and structured, giving plans navigating complex data environments a cleaner, more reliable path.” said Raj Maddireddy, Founder of CoverSelf.

About Abacus Insights
Abacus Insights is a healthcare technology leader with the only data usability platform and solutions built specifically for U.S. payers. Through our platform, payers gain a new level of control and flexibility with their data through accurate, timely, secure, and robust ecosystems that support broadscale analytics and operations. Managing data for 65+ million members, Abacus Insights partners with payers to deliver scalable solutions that drive strategic initiatives, control costs, and improve member lives and experiences. Read about our approach to payment integrity.

About CoverSelf
CoverSelf is a cloud-native payment integrity platform built exclusively for U.S. healthcare payers. Deployed within enterprise health plan environments, CoverSelf gives payers direct ownership of their payment integrity operations -- from pre-pay claims editing to post-pay recovery -- through configurable self-service logic, automated claims orchestration, and full transparency into every rule and outcome. Through its SmartEdit™ concept library and CodeSense™ coding intelligence solution, CoverSelf enables plans across Commercial, Medicare Advantage, and Medicaid lines of business to prevent improper payments at scale, eliminate black-box vendor dependency, and build durable in-house payment integrity programs. CoverSelf is how modern health plans take control. For more information, visit https://www.coverself.com.