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Healthcare

Shift enables health plans to make fast, accurate, high-impact decisions with enriched data and powerful, healthcare-trained AI that enhances payment accuracy, detects and prevents improper payments, and maximizes savings for the plan.

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An evolving problem calls for an evolved approach

Errors, improper payments and fraud, waste and abuse cost the U.S. healthcare industry billions of dollars every year. Shift is revolutionizing the detection, prevention, and management of improper payments. By delivering AI-powered insights, health plans are empowered to take action with speed, impact and accuracy.

Shift Brings AI to Health Plans Across the Claims Lifecycle

Empowering health plans with speed and accuracy throughout the claims process; from prepay claims accuracy to postpay review, with the unparalleled support of our cutting-edge AI solutions.

Prepay
Postpay

Claims Editing

Integrate and monitor NCCI edits, other plan edits and enhance edit library with AI

Claims Auditing

AI-powered claims validation for coding and service alignment and medical record selection

Prepay Overpayment Detection

AI-powered, provider-level scenarios flagging for errors & potential improper payments before a claim is paid

Medical Record Review

Automated, generative AI-powered validation of claims and supporting documentation

Case Management

Streamline workflows, increase collaboration, manage caseloads, and track investigative activity all in a single UI

Postpay FWA Detection

AI-powered detection scenarios capturing FWA and other improper payments with speed and accuracy

Medical Record Review

Automated, generative AI-powered validation of claims and supporting documentation

Case Management

Streamline workflows, increase collaboration, manage caseloads, and track investigative activity all in a single UI

Paying the Costs of Complacency in Healthcare Cost Containment

What are the costs of doing… nothing? The financial future of health plans depends largely on making strong investments in areas of high growth and return. Combating FWA using advanced AI has become critical. With advanced AI for healthcare payment integrity and FWA detection, plans can reduce improper payments, decrease false positives, increase the value of hits and significantly improve collaboration across teams. If plans continue fighting rapidly evolving FWA with the same tools as before, the financial health for most plans is at the mercy of bad actors.

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Learn how Shift AI can help you automate and optimize critical decisions