Our Payment Integrity suite can detect missed opportunities and can unlock cost savings for healthcare payers by providing an intelligent suite of solutions for every critical process along the claim payment lifecycle, from clinical claim review to pre and post-pay chart review and waste and fraud pattern investigation with impressive reporting and analytics.
Automated filters and alerts on providers, labs, members and pharmacies that pose the high risk for potential FWA.
Tracker is an detection FWA filtrations tool that leverages artificial intelligence (AI) to generate analytics that find deficiencies and anomalies and compare peer groups to identify potential FWA early on.
Manage your workloads efficiently and cost effectively while enhancing revenue.
Manager helps to improve documentation requirements and manage caseloads and deadlines, while allowing to manage workloads, track case aging, and record financial performance at the user, city, and product levels.
Use an intelligent data analysis tool, custom designed for user-controlled analysis of healthcare data to discover and isolate questionable billing/payment patterns.
InCompliance simplifies the data-mining process while giving your team control, know how, and efficiency. Identify hidden waste and abuse patterns with ease.
The driving technical force in the quest to reduce FWA is the capability to deploy effective advanced analytics combined with a robust technology platform that can automate the process of ingesting, mapping, integrating, normalizing, and analyzing structured and unstructured “big data” from a variety of sources. Leveraging powerful analytics techniques, such as artificial intelligence, machine learning, predictive modeling, convolutional neural networks, natural language processing, and deep learning algorithms enables agencies and organizations to increase their ability and timeliness to detect FWA, including instances that had previously been undetectable. We streamline and automate labor intensive analytics processes, eliminating thousands of hours of tedious tasks, such as conducting manual FWA audits. Our solutions can tremendously expand FWA and non-compliance audit coverage and detection, compared to limited, randomly selected reviews that leave millions of dollars subsumed by FWA.