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.
Know Your Claim

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