Transform Your Healthcare Data Into Actionable Insights

The healthcare industry has massive amounts of data available in health records, clinical trials, and billing & claims processing systems. However, it’s still challenging for health insurers to unlock the value buried in this data to streamline claim payments, reduce improper payments, drive better provider network performance and patient outcomes, and maintain regulatory compliance.

Shift Improper Payment Detection is an automated, AI-native solution that enables health insurers to detect and prevent improper payments with the power of advanced Artificial Intelligence (AI) analytics and Business Intelligence (BI) logic. It enables users from a variety of teams within a health insurer the ability to analyze behaviors and actions across multiple entities—individual providers and provider networks, third parties, plan members, and more.

THE SOLUTION IDENTIFIES:

• Suspicious claims based on continually updated scenarios
• Suspicious relationships within provider networks
• Suspicious member behaviors 
• Anomalies in care delivery that impact patient experience
• Opportunities for training & education

SHIFT ENABLES HEALTH INSURERS TO:

• Identify & investigate fraud, waste, and abuse more effectively
• Reduce losses due to improper payments
• Prioritize investigative resources based on ROI
• Improve investigator efficiency and shorten decision timeframes
• Optimize provider network performance
• Enhance member quality of care