Know Your Claim

The most innovative and comprehensive Predictive Modeling solution in the industry. The solution comprises of a suite of advanced pre-payment and post-payment analytical platforms to perform behavioral analysis, artificial intelligence and social network analysis on cross-claims data. Unlike rules-based editing, the solution evaluates each claim in the context 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.