InCompliance®
Our Payment Integrity suite empowers healthcare payers to uncover missed opportunities and unlock significant cost savings. This intelligent suite of solutions addresses every critical stage of the claims payment lifecycle, from clinical claim reviews to pre- and post-payment chart audits, and waste and fraud pattern investigations. With advanced reporting and analytics, our suite delivers actionable insights that drive efficiency, accuracy, and savings across the entire payment process.
1
InComplaince Tracker
Automated filters and alerts on providers, labs, members and pharmacies that pose the high risk for potential FWA.
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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.
2
Incompliance Manager
Manage your workloads efficiently and cost effectively while enhancing revenue.
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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.
3
InCompliance Analyser
Uses an intelligent data analysis tool, custom designed for user-controlled analysis of healthcare data to discover and isolate questionable billing/payment patterns.
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InCompliance simplifies the data-mining process while giving your team control, know how, and efficiency. Identify hidden waste and abuse patterns with ease.
Our Approach
The fight against fraud, waste, and abuse (FWA) is powered by advanced analytics and a robust technology platform capable of automating the entire process—from ingesting and mapping to integrating, normalizing, and analyzing vast amounts of structured and unstructured data from diverse sources.
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By utilizing state-of-the-art techniques such as artificial intelligence (AI), machine learning, predictive modeling, convolutional neural networks, natural language processing, and deep learning, organizations can detect FWA more effectively and uncover previously hidden instances with remarkable speed and precision.
Our solutions revolutionize traditional FWA detection by automating labor-intensive processes, eliminating thousands of hours spent on manual audits.
This not only enhances efficiency but also significantly expands audit coverage, uncovering instances of FWA that might otherwise go unnoticed. Compared to outdated, random sampling methods, our approach recovers millions of dollars lost to FWA, delivering superior results and ensuring compliance on an unprecedented scale.
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