Summary: A Managed Care Organization (MCO) needed to comply with state healthcare payment integrity requirements within its first year of operations. They activated Alivia Analytics FWA Finder™. Results:
Summary: A health insurance company needed to improve its payment integrity efficiencies with a primary goal of increasing payment recovery. They engaged Alivia Analytics and used the FWA Finder™. Results:
Summary: One of the largest Third Party Administrators in Canada wanted to streamline its FWA identification and recovery process to increase customer success and revenue. They used Alivia Analytics FWA Finder™ and Alivia Analytics Case Manager™. Results:
Summary: A health insurance company needed to accurately forecast its high-cost drug spend. They used Alivia Analytics Outcome Simulator™ to deliver accurate predictions for their high-cost drug spend. Results:
Enhancing Predictive Accuracy for High-Cost Drug Spend Using Advanced Outcome Simulation Read More »
PAYMENT INTEGRITY Case Study Scenarios With Potential Impacts Quick Links: Recover Missed Overpayments from Legacy Vendor Gaps SCENARIO: A regional health plan serving 1.2 million members seeks a more effective alternative after discovering inconsistent recoveries from its legacy payment integrity vendor. Potential Impact: Health plans may recover tens of millions in missed overpayments annually and
Payment Integrity Audits: Case Study Scenarios With Potential Impacts Read More »
FRAUD DETECTION Over $1.6 Million in Billing Irregularities Discovered Challenge: Strengthening SIU Operations to Combat FWA CareSource, a leading managed care organization offering Medicaid, Medicare Advantage, and Marketplace plans, faced escalating challenges in detecting and preventing fraud, waste, and abuse (FWA) across its diverse lines of business. With rising healthcare costs and increasingly sophisticated fraudulent
CareSource Revamps FWA Detection with Advanced AI Analytics Read More »
FRAUD DETECTION AI-Powered Analytics Yields $50 Return for Every $1 Spent Challenge: Tackling Rising Costs and Fraud in Medicaid The Missouri Medicaid system, serving 1.3 million residents and processing over 100 million claims annually, faced mounting pressure to control costs and improve the detection of fraud, waste, and abuse (FWA). Medicaid spending in Missouri exceeded
Missouri Medicaid Audit & Compliance Transforms FWA Detection Strategy & Results Read More »
Summary: A Medicaid Audit and Compliance Unit needed a fast, efficient, and reliable system for running validation reports and other complex tasks. They chose Alivia Analytics for its superior speed and ease of use. Results:
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