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Average Ratings 0 Ratings
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
Offering early insights to large companies to mitigate employee misconduct and internal risks is the core function of eLoomina. This advanced tool for analyzing employee behavior aims to identify potential misconduct at the earliest stage possible. The statistics reveal that internal fraud costs companies an alarming 5% of their annual revenue, with the average loss per incident reaching $130,000. Additionally, a staggering 22% of internal fraud cases result in losses exceeding $1 million, and these schemes typically last around 16 months. It is significant to note that behavioral warning signs were evident in 85% of these incidents, yet most cases go undetected or are uncovered too late. While 40% of discoveries come from tips, 15% through internal audits, and 13% via management reviews, a mere 3% are identified through technological means, highlighting the pressing need for a more proactive approach to corporate risk management. By implementing eLoomina, organizations can not only safeguard their assets but also foster a more transparent and accountable workplace culture.
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
eLoomina
Country
Israel
Website
www.eloomina.com
Product Features
Product Features
Employee Monitoring
Activity Monitoring
Browsing History
Email Monitoring
Keystroke Recording
Productivity Analysis
Remote Control
Screen Activity Recording
Time & Attendance
Time Tracking