CLAIM AND FRAUD MANAGEMENT

Our Claim and fraud management module is an invaluable asset to the claims management process both for insurers and members. As we move into the future, it only makes sense to take advantage of this technology in every way possible

CLAIM AND FRAUD MANAGEMENT

With thousands of claims, customer queries and large amounts of data that payers need to manage on a daily basis, IntelliProvider aggregate, analyze and link data from thousands of sources and helps you fight healthcare fraud and strengthen investigations with powerful data analytics and visualization technology.

Benefits & Features

Underwriting

Underwriting

Claims Processing

Faster claims processing

Customer Service

Improve Customer Service

Fraud Detection

Fraud Detection

Prevent loss

Prevent loss

atch mistakes as or before they happen

Catch mistakes as or before they happen

Validate claims data and reduce excess claims amounts

Validate claims data and reduce excess claims amounts

INTELLIPAYER ENGINE FOR CLAIMS DATA VALIDATION

The value of claims data validation

There's no denying that incorrect claims are a problem. They're all too easy to miss during an audit, meaning lots of potential funds will potentially vanish! Using IntelliPayer, you could:

  • Prevent loss
  • Catch mistakes as or before they happen
  • Validate claims data and reduce excess claims amounts

Claims data validation is essential. The IntelliPayer engine considers a variety of metrics when scoring the risk and analyzing the results for each claim. It focuses on:

  • Age
  • Gender
  • Full treatment history through machine learning
  • Many Other health metrics

Integrate all your data into one single hub

Linking claims data with census details or electronic medical records helps overcome the lack of clinical data in claims data and increases possibilities for research.

Submitting claims

  • Efficiency in this area lowers patient and medical staff burdens
  • Saves cost
  • Automated claim approvals, image recognition, incentivizing healthy habits to avoid preventable illness claims
Submitting claims

Adjudicating claims

  • Checking coverage and limits, contracting with providers and pharmacies, and appropriate diagnosis and procedure coding
  • Process ordinary applications automatically using claims data
  • Detect unusual price requests early to monitor and prevent any abnormalities.
Adjudicating claims

Monitoring fraud

  • Increased accuracy and reduced loss
  • Machine learning to find fraudulent patterns
  • Limiting false positives and protecting firm reputation
  • Lowering the cost of fraud detection and preventing dealing with the aftermath of fraud
Monitoring fraud

Start making better decisions With scalable health

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