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ClaimQI Prevent
The ClaimQI architecture is designed to maximize AI-driven value and control its inherent risks
ClaimQI Prevent sits on top of the ClaimQI Core engine to amplify detection of claim irregularities and abnormalities. With further sophisticated AI analysis of the claims population, ClaimQI Prevent surfaces claims anomalies and trends that present added financial risk and threats to claims and payment integrity.Â
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ClaimQI Prevent offers risk-based scoring of identified cases, providers and/or claim associations that help to prioritize investigations and action while supporting with detailed intelligence.Â
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As with ClaimQI Core, IT is an added boost to claims intelligence with accuracy, clarity and confidence.Â
POWERFUL CLAIMS INTELLIGENCE:
CONSISTENTLY ACCURATE, PROVEN VALUE
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Prompts attention to new cases or claims that represent heightened risk and urgent action
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Prioritized risk-scoring of claims and groupings based on severity and likelihood, with dollars associated to each
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Identifies provider and/or network associations that may also exhibit similar traits or tendencies in their claims behaviors, extending the risk purview and attention