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Identify new types of inappropriate payments
The system screens all incoming claims in pre- and post-payment and surfaces categories of services that are routinely missed by existing payment integrity tools, arming payers and employers with new insights to achieve the maximum possible savings.
Flag claims with confidence
The system is highly accurate with few false positives and has been validated by peer-review, enabling teams to take confident action against inappropriate payments.
Accelerate time to action
The system flags inappropriate claims in real-time pre-payment, enabling a cost paradigm shift away from pay-and-chase or putting providers on pre-pay watchlists and toward acting at early signs of inappropriateness.
What's included
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Post-Payment Audit
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Pre-Payment Auto-Rejectable Errors API
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Pre-Payment Pause API for Medical Record Review
Peer-Reviewed Study
New England Journal of Medicine Catalyst Peer-Reviewed Study
Learn how Personify Health reduced their overall medical spend by 1.2% in the first year of launch. Validated by NEJM Catalyst.
Case study
Medicare Advantage Plan Case Study
Learn how Health at Scale helped a Medicare Advantage Plan reduce spend and change provider behavior with pre-payment claim flagging and education initiatives.
Brochure
Product Overview
Learn how Precision Fraud, Waste, Abuse and Error Detection™ uses proprietary context-aware AI to identify new categories of inappropriate claims that other systems miss.
Your account is almost complete! To quickly access your account, Q: How can I integrate Precision Fraud, Waste, Abuse and Error Detection™ with my existing systems?
A: Precision Fraud, Waste, Abuse and Error Detection™ can be integrated as an API, through SFTP data transfer, or deployed on premise.
API: The API is directly integrated into the pre-adjudication workflow through API to flag incoming pre-payment claims in real-time. This API is typically integrated before or after any primary or secondary editing platforms.
SFTP: The system can be integrated via SFTP data transfer, whereby a daily pre-paid and/or monthly paid claims file is shared for regular analysis.
On premise: The system can be deployed on premise as part of a custom deployment so that data never leaves the client’s environment.
Q: How does Health at Scale ensure data privacy and security?
A: Health at Scale is SOC II Type 2 certified and upholds strict data privacy and security protocols.
Q: How does the medical record review service work?
A: Health at Scale’s clinician team is available to evaluate medical records on paused or paid claims requiring additional review. The team works with the payer or carrier to request medical records and provides a comprehensive recommendation within a defined SLA from receipt of records to enable swift processing.
Q: Can I use my organization’s clinician or SIU resources to review medical records?
A: Yes, clients can opt to use any existing clinician or SIU resources to review flagged claims and received medical records. For clients who prefer a fully managed offering or would benefit from net new capacity to supplement existing resources, Health at Scale’s clinician team is available to perform this service.
Q: How does Health at Scale work with an employer’s carrier(s) to act on flagged claims?
A: Health at Scale interfaces directly with the employer’s carrier(s) to manage implementation, claims flagging, and medical record review on their behalf.
Q: What level of tracking and reporting is available?
A: All flagged claims are tracked throughout their lifecycle, including tracking medical records received or past due, adjustments made after flagging, and feedback from the payer or carrier. Reporting is offered monthly or quarterly and provides insight into ROI, flagged, in process, and adjusted claims, as well as breakdowns by geography, line of business, carrier, and other categories. Dashboard reporting is available for jumbo clients.
Q: How can I access detailed API information and what customizations are available?
A: Health at Scale works with each client during implementation to define the API and any customizations needed.
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