Insurers need to detect unethical medical billing practices early to reduce claim leakage and process legitimate bills faster. MedSentry® uses predictive analytics and expert clinical analysis to uncover fraudulent medical provider fraud in your billing data. It also delivers detailed reports to help guide investigations.
What You Can’t See Can Hurt You: The Unseen Problem That’s Costing Insurers Billions
MedSentry applies advanced analytics to your medical bills and provides a risk score for every medical provider in your book of business. It then produces a report detailing specific issues in your billing data as well as clinical analysis that describes the suspect behavior and what to investigate.
Learn how MedSentry reduces your medical billing exposure.
Learn how a top 10 insurer used MedSentry to uncover over $170K in questionable bills from a physical therapy practice.
Easy implementation delivers substantial ROI. As a SaaS solution, MedSentry requires minimal IT lift.
ClaimSearch® is more than the world’s largest database of property/casualty claims—it’s also a robust claims intelligence platform. Its claims-matching technology is an essential first step in fraud detection, and the results can help facilitate fast-tracking. The platform also provides seamless access to integrated claims fraud-detection and investigative analysis tools.
Insurers need to determine quickly and efficiently whether a claim is likely to be fraudulent—or if it can be fast-tracked for settlement. ClaimDirectorSM uses the power of predictive analytics to score claims with greater accuracy and reveal questionable attributes.
Discover the hidden connections among claimants, providers, and businesses to help identify organized insurance fraud. NetMap’s advanced analytics greatly enhance the SIU’s ability to discover fraud rings within their company’s claims. The software quickly evaluates claim information, public records, and other data to reveal patterns indicative of fraud.
Find the critical data you need at FNOL (first notice of loss) to help complete claims quickly and spot potential fraud. Decision Net® helps fill in the gaps with supplemental claims information from best-in-class sources. This extensive resource helps claims teams improve decision making, expedite meritorious claims, and increase the impact of SIU referrals.
Special investigations units are experiencing new challenges with complex cases, increased fraud, and stringent regulatory requirements. Case Manager™ is a fully configurable fraud management solution that improves productivity and efficiency by automating triage, assignment, and compliance reporting.
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