Our Solutions

Retrospective Claims Analysis

Comprehensive Payment Integrity — Prospective and Retrospective.

Prospective payment integrity solutions are becoming increasingly important for health plans seeking to increase payment integrity and strengthen provider relationships. Pilot Information Systems makes this possible with lightning-fast processing — returning claims files in under 20 minutes to enable true prospective payment review.

Retrospective analysis remains a cornerstone of a complete payment integrity strategy, providing the insight needed to identify patterns, prevent future errors, and recover missed savings. With Pilot, you can run retrospective reviews on any set of claims, for any time period, backed by unlimited claims history for greater accuracy and deeper analysis.

The result: a balanced, end-to-end payment integrity program that delivers confidence, control, and measurable savings.

Custom Claim Rules — Built Around You

At Pilot Information Systems, our commitment to automation, speed, and client satisfaction gives us the agility to adapt quickly to new industry trends — and deliver results faster than anyone else.

While most competitors take a year or more to add new edits, Pilot can design, develop, test, and implement them in just weeks. Even better, we create custom claim edits tailored to your state and local requirements — a level of service no competitor can match.

Our clients rely on over 60 years of combined managed care and IT experience, backed by responsive, expert support that’s handled quickly and always to their satisfaction. The difference: with Pilot, you don’t wait for innovation — you lead it.

Cost Containment & Overpayment Identification

Unlock the Hidden Savings in Your Claims Data.

Pilot’s Overpayment and Recovery System (OaRS) uncovers overpayments by mining your database with 25+ industry-standard edits — delivering the same powerful results as competitors, but at a fraction of the cost.

In today’s crowded marketplace, many vendors claim to stand out through how they “apply” their edits. But here’s the reality: industry-standard edits are just that — standard. That’s why Pilot focuses on what truly makes a difference — cost efficiency, speed, customization, and accuracy.

Our Service Models

Pilot offers flexible deployment options designed to fit your organization’s operational and security requirements. Our primary delivery method is Software as a Service (SaaS), which provides fast, secure, and scalable access to Pilot’s full suite of payment integrity tools.

Through a secure VPN connection to our SSAE 18 Type II (SOC 2) certified servers, clients can transmit claims data with complete confidence in its security and privacy. This model allows claims to be processed in large batches or incrementally throughout the day.

For clients with specialized environments or additional regulatory requirements, Pilot also offers on-premise or hybrid deployment options, ensuring our solutions adapt to your infrastructure — not the other way around.

“From an IT perspective, Pilot’s Information System is a pleasure to work with. Their collaborative approach made integration smooth, secure, and fully compliant with our IT standards. The entire setup process was completed quickly, efficiently, and without disruption.”

Wilson Curbelo
IT Director, Plan de Salud Menonita

“Pilot Information Systems has completely transformed our claims process. Their personalized service, fast updates, and seamless integration have greatly improved our efficiency. Highly recommend them for healthcare cost containment.”

Maria Hernandez