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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
Provide your advisors and policyholders with comprehensive, real-time guidance to help them select the most suitable coverage for their specific requirements. Utilize cutting-edge data to make a significant impact in the industry. Facilitate remote operations through intelligent applications. Enhance distribution and customer service to deliver unparalleled experiences for your clients. Equip your organization with new skills and knowledge across all business areas. Operate within our secure cloud environment or on-premises, ensuring enterprise-level data anonymization, traceability, and compliance with regulations such as IDD and GDPR. Effortlessly integrate with your existing systems through swift collaborations with partners like Salesforce, Microsoft 365, and Guidewire. From policy acquisition to claims management, implement and oversee essential AI-driven processes in real-time without sacrificing the integrity of fraud detection. This holistic approach not only enhances operational efficiency but also fosters a culture of innovation within the organization.
API Access
Has API
API Access
Has API
Integrations
Salesforce
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
Zelros
Founded
2016
Country
France
Website
www.zelros.com
Product Features
Product Features
Insurance Agency
Claims Management
Commission Management
Contact Management
Document Management
Insurance Rating
Life & Health
Policy Management
Property & Casualty
Quote Management