Fraud/Abuse prevention for Healthcare Insurance Analytics

Fraud/Abuse Prevention for Healthcare Analytics


Duplicate Encounters

Duplicate Encounters

To cover their tracks, fraudsters sometimes indulge in multiple applications during encounters in a single day. But through user profile tracking and more, this tool will help you minimise these occurrences.

Duplicate claims

The same applies to claims. Unfortunately, the loss incurred if this is not plugged right at the initial stages can be significant. Know if providers are submitting multiple claims in a period of 24 hours.

Claim count from the provider by ICD10 / Procedure code

A vital code in your industry, we help you track the number of claims and payments made on it.

Readmission count by provider

Analytics will identify claims that are being submitted within a period of 30 days since it was first submitted. I help you ascertain the level of urgency conveyed by the provider.