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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.
Description
Accelerate your due diligence processes and resolve issues more efficiently by utilizing investigative products that provide actionable insights into individuals, assets, and their connections. Enhance the speed of your investigations while improving your ability to find subjects, recover assets, and collect outstanding debts. Forge connections between people, properties, and enterprises by leveraging an extensive array of over 10,000 public and proprietary data sources that are refreshed daily, all supported by the TLOxp® platform. Utilize adaptable and user-friendly tools to link individuals with their assets and businesses effectively. Increase operational efficiency by revealing essential information even from incomplete data sets. Examine potential red flags, confirm claims, and pursue debt recovery using the latest intelligence available. Additionally, compile comprehensive information regarding individuals, businesses, and assets to assess and comprehend potential risks associated with your inquiries. By doing so, you can make informed decisions that mitigate risk and enhance your overall investigative capabilities.
API Access
Has API
API Access
Has API
Integrations
No details available.
Integrations
No details available.
Pricing Details
No price information available.
Free Trial
Free Version
Pricing Details
No price information available.
Free Trial
Free Version
Deployment
Web-Based
On-Premises
iPhone App
iPad App
Android App
Windows
Mac
Linux
Chromebook
Deployment
Web-Based
On-Premises
iPhone App
iPad App
Android App
Windows
Mac
Linux
Chromebook
Customer Support
Business Hours
Live Rep (24/7)
Online Support
Customer Support
Business Hours
Live Rep (24/7)
Online Support
Types of Training
Training Docs
Webinars
Live Training (Online)
In Person
Types of Training
Training Docs
Webinars
Live Training (Online)
In Person
Vendor Details
Company Name
Shift Technology
Founded
2013
Country
France
Website
www.shift-technology.com/products/payment-integrity
Vendor Details
Company Name
TransUnion
Founded
1968
Country
United States
Website
www.transunion.com/solution/trulookup