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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
eOxegen is an innovative claims management system powered by artificial intelligence, aimed at improving the efficiency of health insurance operations. By automating the claims process through a Straight Through Process (STP), it minimizes the need for manual intervention, resulting in quicker claim settlements and higher accuracy. The system features sophisticated fraud detection capabilities, leveraging AI algorithms to detect and flag potentially fraudulent activities at an early stage. Furthermore, eOxegen includes functionalities such as provider contracting and empanelment, management of pre-authorizations and adjudication, as well as comprehensive reporting through business intelligence analytics dashboards. Its AI-driven workflow automation guarantees consistent task execution, reduces repetitive activities, and boosts overall productivity. In integrating these diverse functionalities, eOxegen enables insurance providers and third-party administrators to refine their claims management processes while also lowering operational costs. Ultimately, the platform serves as a transformative tool for the health insurance industry, fostering a more efficient and reliable claims handling environment.
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
eOxegen
Founded
2002
Country
India
Website
eoxegen.com
Product Features
Product Features
Insurance Claims Management
CRM
Claims tracking
Customer portal
Document management
EDI data exchange integrations
Electronic claims
Fraud management
Reporting