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Improper Payment Detection

Uncover Healthcare Fraud, Waste and Abuse With Speed and Accuracy

Detect and prevent improper payments with a focus on high-value cases and maximum ROI

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Fraudsters don’t play by the rules. Your detection strategy shouldn’t either.

Shift’s healthcare-trained AI models go beyond static, rules-based detection methods to increase detection accuracy, uncover higher-value healthcare fraud, waste and abuse, and boost the efficiency of investigators.

Boost investigative efficiency by 200%
Boost investigative efficiency by 200% Increase detection accuracy by 3x Uncover 4x higher value FWA Seamless investigative workflows
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Boost investigative efficiency by 200%
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Increase detection accuracy by 3x
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Uncover 4x higher value FWA
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Seamless investigative workflows
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Investigators should spend their time investigating. They shouldn’t waste time combing through sources for the right data or information. With enhanced plan data, combined with extensive external data, Shift gets the right insights to investigators faster.  

Investigative detail all in one place

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Skip hours spent compiling data and information with claim and provider details, online reviews, exclusion lists and much more already integrated into the platform.

Uncover related providers

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Alerts with context and action

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Any data, any format

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Powerful detection across the full Payment Integrity lifecycle

Pre Payment Detection
Pre Payment Detection Post Payment Detection Case Management
Pre Payment Detection
Post Payment Detection
Case Management
Increase savings by stopping FWA prior to payment.
Shift enables lightning-fast detection and decisions before a claim is paid. Shift's AI-powered, real-time analysis stops emerging schemes in their tracks. Combined with enhanced external data, investigators are equipped with the context behind the alert to quickly conduct investigations and reduce provider abrasion.

TIME TO SHIFT AWAY FROM THE TRADITIONAL FWA DETECTION APPROACH

Healthcare fraud, waste and abuse is constantly changing - is the traditional approach enough? Dive into the traditional approaches to fraud, waste and abuse detection using rules-based tactics and the increasing shortfalls in relation to evolving fraud and demands from health plans. Learn how an AI-driven approach to improper payment detection can upend traditional approaches, with actionable insights and increased collaboration across the plan.

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ShiftLeft: time to shift away from the traditional FWA detection approach
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Learn how Shift can help you successfully identify, investigate and prevent more fraud

 

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