Improper Payment Detection

Uncover Healthcare Fraud, Waste and Abuse With Speed and Accuracy

Detect and prevent improper payments with a focus on high-value cases and maximum ROI

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Boost investigative efficiency by 200%

Increase detection accuracy by 3x

Uncover 4x higher value FWA

Seamless investigative workflows

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 related providers

Alerts with context and action

Any data, any format

Predictive variables

Advanced AI models combined with extensive external data capture evolving activity invisible to static, rules-based scenarios

Entity resolution

Continuous learning

Natural language processing

Simplify complex fraud

A detection engine that evolves with the complexity of today’s schemes, automatically uncovering deeper connections, relationships and higher value cases

Related entities

Network analysis

Related alerts

Assign & triage cases

Get coverage on the cases that matter most with intuitive alert prioritization and assignment features.

Streamline communication

Activity tracking

KPIs & reporting

Powerful detection across the full Payment Integrity lifecycle

Pre Payment Detection

Post Payment Detection

Case Management

Increase savings by stopping FWA prior to payment.

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

TIME TO SHIFT AWAY FROM THE TRADITIONAL FWA DETECTION APPROACH

Healthcare fraud, waste and abuse is constantly changing - is the traditional approach enough? Dive into the traditional approaches to fraud, waste and abuse detection using rules-based tactics and the increasing shortfalls in relation to evolving fraud and demands from health plans. Learn how an AI driven approach to improper payment detection can upend traditional approaches, with actionable insights and increased collaboration across the plan.

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