Know Your Claim
Know Your Claim (KYC) comprise of six modules and Medicaid-specific fraud detection models to deliver comprehensive monitoring and analysis of claims against cross-claims data.
Predictive analytics for detecting fraud in provider claims
- Provides savings in excess of three times by avoiding costly post-payment recovery
- Minimizes fraud prevention and hence losses to the enterprises
- Helps improve provider relations by narrowing the set of suspicious claims
- Enhances efficiency of existing workforce by significantly reducing false positives
Key Capabilities
- Predictive Analytics Best-of-breed behavioural, network and predictive analytics algorithms
- Intelligent Correlation Correlation with commercial provider demographic and profile data
- Alerts on Claims Near-time alerts on high-risk claims, providers, beneficiaries and vulnerabilities
- Electronic Investigation High-speed digital investigation based on 360 degree views and associated spatial, temporal and link analysis
- Configurable Workflow Integrated digital workflow to triage and decision on alerts including medical records review
- Command and Control Dashboards monitor, measure, and respond to ongoing risks and vulnerabilities