Payment Integrity

Maximize savings, minimize errors with AI-driven payment accuracy

Customizable edits, continuously optimized scenarios, accelerated workflows. Take control of your payment integrity at critical steps of the healthcare claims process.

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Catch issues before they cost you.

As your payment integrity strategy shifts left, make sure you get it right. Shift’s payment integrity solution delivers AI-driven accuracy at key points in the claims process—analyzing policy, provider behavior, and records to prevent costly errors and identify emerging schemes. Shift empowers health plans to act quickly and precisely, boosting prepay savings and postpay recoveries.

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Accelerated medical record review

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Thousands of continually updated edits

Keep a pulse on policy and plan guidelines with automatic updates of code sets and industry releases

Deployable at any stage

Customizable and tested

Fully auditable & explainable

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GenAI-powered review

Using powerful LLMs, records are analyzed for appropriate coding, sufficiency of supporting documentation or alignment with plan policy or guidelines.

Bookmark & highlight records

Explainable insights

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Concepts and models

Leverage industry leading concepts and continuously learning AI models to detect hidden patterns, anomalies and other trends in plan data

Enriched with external data

Explainable insights

Reporting

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Investigative detail all in one place

Skip hours spent compiling data and information with claim and provider details, online reviews, exclusion lists, and much more already integrated into the platform

Uncover emerging schemes

Uncover suspicious networks

Streamlined case management

Powerful detection across the full Payment Integrity lifecycle

Shift’s payment integrity solution enables lightning-fast detection and decisioning before a claim is paid. Shift's AI-powered, real-time analysis stops emerging schemes in their tracks. Combined with enhanced external data, teams are equipped with the context behind the decision or alert to quickly conduct investigations and reduce provider abrasion.

Accelerating Payment Integrity with Generative AI

As the care delivery, policy and payment landscape evolves, payment integrity innovation must keep up. Learn how modern tools such as generative AI can help teams take on the challenges in the wake of policy or care delivery changes, medical record and other document review, and reducing provider abrasion with fast, accurate analysis of claims.

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