Know Your Claim is the most innovative and comprehensive Predictive Modeling solution in the industry. It comprise of a suite of advanced pre-payment and post-payment analytical platforms to perform behavioral analysis, artificial intelligence and social analysis on cross-claims data.
Unlike rule-based editing, the solution evaluates each claim in the context of of all related and similar claims using forensic-style hyper-dimensional analysis to detect claims associated with fraud and abuse. In contrast to the utilization based provider outlier analysis, the approach focuses on the improbabilities associated with individual encounters represented by the claims.
Best-of-breed behavioral, network and predictive analytics algorithms
Correlation with commercial provider demographic and profile data
High-speed digital investigation based on 360 degree views and associated spatial, temporal and link analysis
Integrated digital workflow to triage and decision on alerts including medical records review