Security + Compliance

Transparency in Coverage

Which providers have had issues with CMS?

How often do we pay full price for out-of-network services?

What can I do about claims from out-of-network providers using in-network facilities?

How much could we save enforcing provider compliance at point of payment?

Do our members understand what they’ll owe before care?

Introducing Daylight: Transparency in Coverage

Real-time claims intelligence + transparency in one engine.
  • Daylight Price Comparison Tool — NSA-compliant + member-accessible
  • FWA Analytics Engine — Detects upcoding, unbundling, phantom billing, duplicate charges
  • Overpayment Prevention — Stops inflated claims before disbursement
  • QPA & Benchmarking — Know what’s fair, not just what’s billed
  • Claim-Based Quality Scoring — Links survey and outcome data to specific providers
  • Member Transparency Dashboard — Easy-to-understand pricing + provider insights
  • Natural Language Question Engine — Ask “Which orthopedic claims over $15k were out-of-network in Q2?” and get answers instantly

Plus:

  • 30% reduction in inappropriate or inflated payments
  • Millions in potential recovery via targeted post-payment audits
  • 100% member-facing compliance with Transparency in Coverage rules
  • AI-powered anomaly detection & audit trail generation
  • Risk scoring for providers, claim categories, and individual encounters

Control Claims. Maximize Value. Defend Every Dollar.

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