Post-Pay FWA Recovery Analytics
Why Alivia?
- AI identifies patterns missed by traditional detection
- Clinical and coding experts validate overpayments
- Prebuilt audit workflows across DRG, SNF, and behavioral health
- Centralized SIU case tracking and evidence management
- Custom dashboards with ROI, trends, and outcomes
Powered by Alivia 360™ Platform
Recovery analytics are unified through one platform, combining AI detection, audit workflows, case tracking, and expert insights. With seamless integration across post-pay processes, Alivia 360™ helps payers recover more, resolve cases faster, and strengthen FWA outcomes.
ONE PLATFORM for FWA powers earlier action—stopping high-risk providers at the source and sharing insights across the claims lifecycle.
Maximizing Payment Integrity with Alivia's Advanced Post-Pay Solutions
Alivia Analytics offers a robust suite of post-pay recovery solutions designed to ensure payment integrity and combat fraud, waste, and abuse (FWA) in healthcare. These advanced solutions are crucial for healthcare payers, health plans, and government programs seeking to mitigate financial losses, optimize medical spend, and ensure claims accuracy.
At the core of their offerings is FWA Finder™, an AI-driven platform that provides precision analytics for fraud detection. It leverages machine learning to uncover hidden fraud risks and generates actionable investigative leads faster with AI identifying patterns missed by traditional detection. This is achieved through intelligent analysis of post-pay claims data, identifying complex patterns like upcoding, unbundling, phantom billing, and provider anomalies.
To streamline the investigative process, Alivia provides Alivia Case Manager™. This centralized, scalable case management solution helps healthcare organizations track, manage, and resolve complex fraud cases efficiently with centralized SIU case tracking and evidence management, accelerating case resolution and recovery efforts for detected overpayments.
Alivia also delivers Comprehensive Clinical Audit Solutions, where expert clinical auditors validate overpayments and review high-risk post-pay claims to ensure medical necessity and reduce overpayments. These solutions include prebuilt audit workflows across DRG, SNF, and behavioral health. Complementing this is their Data Mining Health Plan Solutions, which utilizes powerful post-pay analytics to identify billing anomalies, duplicates, and trends that indicate hidden errors and non-compliant practices.
Finally, for specialized support, Alivia offers SIU Services. This augments internal Special Investigations Unit (SIU) teams with expert investigators and coders, providing essential investigative support to further accelerate case resolution and maximize financial recoveries. All these efforts are supported by custom dashboards with ROI, trends, and outcomes, ensuring a complete and efficient payment integrity lifecycle.
