Optimize Your Payment Integrity Performance

Healthcare payment integrity.  It’s a simple phrase used to describe an ever-growing and increasingly complicated task.  

The complexity of claim payment processes has made them not only error-prone but also prime targets for fraud, waste and abuse. These problems have become so significant and pervasive that solving them now requires more than just human effort. 

That’s where Alivia Analytics comes in.  Our solutions deliver unmatched AI-driven power, scalability and breadth of coverage. We enable claims payers and processors to build and sustain optimal levels of integrity in their operations. 

Request a Demo

Alivia Analytics’ Absolute Insight solution is a new and powerful weapon in the fight against errors and fraud, waste and abuse (FWA) in healthcare claim payments.

Here’s how it works.

Healthcare Payment Integrity Analysis and Action – Made Easy

With its cloud-based architecture and analytical tools developed explicitly for healthcare payment processes, Absolute Insight enables payers to manage and explore all of their data faster and with more granularity than ever before. 

Absolute Insight unifies and harmonizes disparate payment data, including data from 3rd parties. It applies rules-based and machine learning-powered algorithms to full data sets to uncover suspicious patterns and anomalies. 

It also provides tools that let investigators quickly drill down on potential problems and prioritize their remediation efforts.  Best of all, with its simple, ‘point and click’ UI, Absolute Insight makes it easy, even for non-technical users, to harness and direct its powerful capabilities. 

Absolute Insight enables customers to find and fix problems quickly to improve their operational efficiency and drive better results. It also lets organizations showcase how they’re using the latest technology to achieve their business goals.

For unmatched payment integrity, its Absolute Insight from Alivia Analytics.

FIVE REASONS WHY YOU SHOULD CONSIDER ABSOLUTE INSIGHT

Following are five advanced features and functions of Absolute Insight that set it apart from any other product available today. It enables healthcare claim payers, processors and their staff members to:

  • Use pre-built predictive models to quickly zero-in on FWA

  • Easily modify the predictive models to meet specific requirements

  • Uncover suspicious relationships between entities of interest

  • Identify high-value and high-impact cases for further action

  • Utilize the intuitive workflow module to manage cases better

     

computer

Models and Algorithms

Absolute Insight ships with numerous algorithms included, all of which were developed specifically for use with healthcare claims payment data. For example, its novel clustering algorithms can help users find similar providers to investigate after a successful case is closed and even distinguish between fraud, waste and abuse. At the regional level, insurers may have to configure certain models to reflect their region’s policies and their contract requirements. The good news is that the Alivia team configures these models for customers during the implementation process.  This approach minimizes false positives, as every scheme is customized for maximum effectiveness. 

The algorithm results are synthesized to create a composite risk score for every provider in a customer’s system. Using unsupervised machine-learning, Absolute Insight can find the providers that stand out the most and will produce the highest ROI per case. This is how Alivia’s patent-pending deep-learning algorithms deliver the most effective ways to identify fraud, waste and abuse.

Security

We know that organizations in the healthcare sector are favorite targets for cybercriminals. To protect customers from attacks that are growing in both numbers and sophistication, we’ve achieved SOC compliance. Security features and functions are enacted at the network, OS, application, and database levels, all backed by a robust set of security policies.

yinyang

Data Harmonization, Integration and Querying

Fraud investigators often struggle because they lack unified, end-to-end views of their processes. Without the full picture, they resort to manually pulling together disparate data from varied sources. Time-consuming and error-prone, these efforts bog down fraud detection efforts and reduce their effectiveness.

Alivia Analytics removes this roadblock with data harmonization. This hallmark of Alivia’s solutions includes automated processes for enterprise-wide data collection, and for combining and ‘flattening’ the data so it’s analytics-ready. And it’s all done with speed at scale. 

Absolute Insight integrates easily with multiple open-source and proprietary libraries. Data can be sourced from a variety of flat-file types, Excel spreadsheets, SQL Server instances, HDFS clusters, and more. Customers can also create direct connections with their reporting databases or provide extracts which they can upload to Absolute Insight in the cloud via SFTP or ETL processes. 

They’re all easy options, so it merely depends on the customer’s needs and preferences.

Absolute Insight’s QueryBuilder offers a similar approach for creating SQL queries. Business users can leverage the solution’s simplified interface to generate SQL queries, while more technical users can write SQL code directly. This code runs on Alivia’s backend SQL Server database which can scale elastically based on the client’s workload. 

Contact Us Today

We offer powerful yet easy ways to break through complexity, take change in stride, and eliminate departmental and process boundaries. 

Our solutions will increase your organization’s effectiveness by providing greater visibility, virtually unlimited scale, and tremendous usability. It’s an unbeatable combination of features that far surpasses anything else on the market today. 

We’re ready to help you take your organization’s payment integrity to the next level.  Take the first step and contact us today.