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ClaimQI Prevent

Powered by its Core engine, ClaimQI Prevent boosts claims intelligence across the population to identify threats and risks and support investigations with unprecedented claim-level detail. 

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. 

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After ClaimQI Core evaluates every claim against the policy rules that govern, ClaimQI Prevent detects statistical anomalies and trends that require investigation. Risk Analysis workflow alerts to imminent threats and offers risk-based scoring of identified cases, providers and/or associations.

 

Core + Prevent brings an added boost to claims intelligence with accuracy, clarity and confidence.
This helps to prioritize investigations and action, while supporting your teams with unprecedented claim-level detail and citation-backed intelligence. 

AI and LLMs generate executable rules-based logic, turning unstructured data and text into deterministic evaluator outcomes. Claims data is not interpreted by AI allowing us to ensure consistent and accurate results every time against the rules that govern

POWERFUL CLAIMS INTELLIGENCE:
Identifying and prioritizing claims risk to avoid costly payments before they are made

  • Prompts attention to new cases or claims that represent heightened risk and urgent action
     

  • Prioritized risk-scoring of claims and groupings based on severity and likelihood, with dollars associated to each
     

  • Identifies provider and/or network associations that may also exhibit similar traits or tendencies in their claims behaviors, extending the risk purview and attention

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