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Average Ratings 0 Ratings

Total
ease
features
design
support

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Write a Review

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

Screenshots View All

Screenshots View All

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

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