Average Ratings 0 Ratings
Average Ratings 0 Ratings
Description
ClaimScore stands out as the sole independent software solution focused on tackling the growing issue of claim fraud within class action settlements. Each claim is meticulously assessed on an individual basis through our unique AI, ML, and Cloud Architecture in real-time, with results displayed instantly on an interactive dashboard. Initially, every claim starts with a ClaimScore of 1,000, which diminishes whenever it does not meet a specific criterion. These criteria are assigned either fixed or variable weights based on their relationship to fraudulent and legitimate claims. To enhance transparency, every claim is accompanied by deduction codes that correspond to the failed criteria, ensuring that all involved parties, including the administrator and the court, are fully informed of the precise reasons behind any claim rejection. This meticulous approach not only fosters trust among stakeholders but also reinforces the integrity of the claims process.
Description
Shift’s Payment Integrity offers an advanced AI-driven solution tailored for health plans, aimed at enhancing the precision and minimizing expenses involved in the claims payment process. This innovative tool operates effectively during both pre-payment and post-payment phases, enabling plan administrators to identify potential issues early on while also recovering overpayments efficiently. Among its notable features are dynamic claims editing with updated rules, AI-supported reviews of medical records, detection of anomalies as well as instances of fraud, waste, and abuse, and integration of external data for a more comprehensive analysis. The system is designed to adapt to changing policies and guidelines, featuring automated policy assessments and an edit logic workbench that allows health plans to experiment with concepts prior to implementation. It also includes clear flags and alerts that inform reviewers about the reasons behind claim flagging, facilitates faster document reviews by emphasizing key sections of records, and employs data mining techniques to uncover emerging trends. Additionally, the platform boasts a cohesive case management interface that streamlines investigative workflows, further enhancing operational efficiency for health plans.
API Access
Has API
No
API Access
Has API
No
Integrations
No details available.
Integrations
No details available.
Pricing Details
No price information available.
Free Trial
No
Free Version
No
Pricing Details
No price information available.
Free Trial
No
Free Version
No
Deployment
Web-Based
Yes
On-Premises
No
iPhone App
No
iPad App
No
Android App
No
Windows
No
Mac
No
Linux
No
Chromebook
No
Deployment
Web-Based
Yes
On-Premises
No
iPhone App
No
iPad App
No
Android App
No
Windows
No
Mac
No
Linux
No
Chromebook
No
Customer Support
Business Hours
Yes
Live Rep (24/7)
No
Online Support
Yes
Customer Support
Business Hours
No
Live Rep (24/7)
No
Online Support
Yes
Types of Training
Training Docs
No
Webinars
No
Live Training (Online)
No
In Person
No
Types of Training
Training Docs
Yes
Webinars
Yes
Live Training (Online)
Yes
In Person
No
Vendor Details
Company Name
ClaimScore
Founded
2022
Country
United States
Website
www.claimscore.ai
Vendor Details
Company Name
Shift Technology
Founded
2013
Country
France
Website
www.shift-technology.com/products/payment-integrity
Product Features
Insurance Claims Management
CRM
No
Claims tracking
No
Customer portal
No
Document management
No
EDI data exchange integrations
No
Electronic claims
No
Fraud management
No
Reporting
No