ePathUSA Inc

ePathUSA is a trusted CMS partner supporting multiple mission-critical programs across healthcare operations, medical review, program integrity, data management, analytics, and digital transformation initiatives. Our teams work closely with CMS stakeholders to help improve operational efficiency, strengthen oversight capabilities, enhance data-driven decision-making, and support CMS's mission of ensuring quality healthcare services for millions of Medicare and Medicaid beneficiaries.
A significant portion of our experience has been supporting CMS medical review programs, where we help improve the accuracy, consistency, and effectiveness of medical review activities. Through this work, we have developed a deep understanding of medical record review processes, claims analysis, healthcare regulations, contractor oversight, quality assurance, and program integrity operations. Our experience supporting medical review initiatives enables us to identify trends, support performance measurement, enhance reporting and analytics, and contribute to the continuous improvement of CMS review programs.
Beyond medical review, ePathUSA supports CMS initiatives involving healthcare data analytics, contractor performance management, business process optimization, data governance, and modernization efforts. We combine deep healthcare domain expertise with advanced technology capabilities, including Artificial Intelligence, Machine Learning, Cloud Solutions, and Data Analytics, to help CMS address complex operational challenges.
Most recently, CMS selected ePathUSA as the Prime Contractor for the Artificial Intelligence Medical Record Review (AI MRR) Pilot. This innovative initiative leverages AI and advanced analytics to improve the efficiency, consistency, and accuracy of medical record reviews while strengthening program integrity. The award reflects CMS's confidence in ePathUSA's ability to combine healthcare expertise with emerging technologies to deliver meaningful outcomes.
Our experience across multiple CMS organizations and programs allows us to bring a comprehensive understanding of healthcare operations, medical review, and modernization, making ePathUSA a trusted partner in advancing CMS's mission and strategic objectives.