Claims presented in time based episodic context
Rules-based, data-mining and profiling techniques are applied to automatically detect situations with errors in coding, double-billing, eligibility, coordination of benefits, outliers, contract compliance as well as other such common billing and claim processing issues, inconsistencies, suspicious activity.
Simplifies monitoring and management of audit operations, and drives actionable insights from auditing experience.
Couples claim payment technology with superior auditing platform.
Produces highly scalable, productive results
Significantly improves effectiveness of claim audit operations.
Customized to payer payment policies, medical policies, contracts.