Alivia Analytics Solutions

SOLVING COMPLEX CHALLENGES

We help health plans and government agencies address financial losses caused by FWA, errors, missed recoveries, fragmented data, and outdated processes.

Pre-Pay Preventive Analytics

Our FWA Claims Manager™ flags high-risk providers before payment using advanced scoring, configurable pend-and-review triggers, and built-in compliance checks—helping reduce improper payments and streamline early case review.

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Post-Pay Recovery Analytics

Our FWA Finderâ„¢ uncovers hidden leads and accelerates SIU investigations, while Alivia Case Managerâ„¢ streamlines case volumes and workflows. Combined with Clinical Audits and Data Mining, we recover more from overlooked FWA and errors.

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Innovative Data & IT Services

Our DataChromeâ„¢ standardizes claims data into analytics-ready formats and supports all ingestion needs. We also optimize and migrate Claims Systems and Safeguard PHI, advancing payer transformation with secure, scalable infrastructure.

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All Alivia Solutions

All
Preventative Analytics
Recovery Analytics
Data & IT

Claim System Modernization

Modernize core claims platforms by planning and executing migrations to TriZetto Facets®, QNXT™, and HealthRules® Payer while reducing implementation risk and maintaining operational continuity.

FWA Claims Manager™ − Pre-Payment Prevention of Healthcare Fraud

Stop high-risk providers at the source before payments are made, preventing financial impact and limiting resources…

Healthcare Claims Edit Engine

Validates claims as a primary, secondary, and/or post-payment editor backed by industry experts and advanced technology…

FWA Finder™ – Precision Analytics for Fraud Detection

Uncover hidden fraud risks and generate leads faster with AI-driven post-pay claims intelligence…

Alivia Case Manager™ – Streamlined Healthcare Fraud Case Management

Track, manage, and resolve complex fraud cases faster with a centralized, scalable post-pay case solution…

Comprehensive Clinical Audit Solutions

Ensure medical necessity and reduce overpayments with expert clinical audits across high-risk post-pay claims…

Data Mining Health Plan Solutions

Identify billing anomalies, duplicates, and trends with powerful post-pay analytics that uncover hidden errors…

SIU Services – Pursuit Beyond Fraud Detection

Augment your SIU team with expert investigators and coders to accelerate case resolution and recovery…

Insights for Aging Systems & Data

Bring clarity to aging systems, code, and data environments with AI-assisted insights. LegacyIQâ„¢ helps healthcare payer IT leaders stabilize critical technology, modernize with confidence, and prepare trusted data for AI.

Healthcare Data De‑Identification

Safeguard patient privacy and support regulatory compliance with advanced data masking that protects PHI, enabling the safe use of healthcare data in non-production environments, including X12 EDI.

Consolidate Claims Data

DataChromeâ„¢ consolidates and standardizes fragmented claims and operational data into trusted, analytics-ready formats to support faster analytics, payment integrity, and enterprise data strategies.

Specialized Staffing Services

Sustain critical operations with IT talent and flexible staffing models across Medicaid and commercial health plan environments, including configuration, testing, EDI, project management, development, and legacy platform expertise.