Move away from the pay and chase paradigm by shifting from a retroactive to a prospective approach to fraud detection. PayAssure employs the industry’s most comprehensive sets of analytics, tools, and services to assist you in eliminating fraud and abuse at every stage of the process, from detection to prevention to recovery.
PayAssure addresses payers’ increased fraud surveillance and detection demands with a holistic analytics-led strategy. Using the power of various entity risks and powerful AI/ML algorithms, we work to limit false positives and prioritize the highest risk claims.
See how Apexon helps payers function efficiently, lowering time spent on manual processing, fraud prediction, loss identification, thereby enhancing medical loss ratios, saving expenses and maximizing payments efficiently.
AI/ML-based insights help in proactive claim scoring and review processes that lowers the risk of bad debt and minimizes revenue loss due to fraud.
Our Quantitative Scoring Claims algorithms assists payers in identifying outliers linked to quantity overutilization and detection if a duplicate claim is invoiced by the provider.
Identify outliers connected to frequent billing of medically unnecessary treatment, less likely procedure codes, and inappropriate coding methods, and eliminate financial leakages for payers at the physician level.
Our Predictive Risk Scoring model allows payers to audit only 10% of the most erroneous cases, saving time and effort over the manual approach while still collecting an equal number of errors.
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