GIVE YOUR FRAUD INVESTIGATORS THE TOOL THEY NEED TO MAXIMIZE RESULTS.
FraudScope empowers risk analysts and investigators by enabling them to identify the worst threats, prioritize the biggest dollar amounts, and focus limited resources on the most egregious fraud cases.
Sophisticated Adaptive Technology
- Uses advanced technology developed at the Georgia Institute of Technology
- Automatically identifies emerging fraud, waste and abuse in a timely manner before claims are paid
- Prioritizes claims to ensure SIU personnel time is spent on cases that will yield maximum savings
- Underlying AI translates risk scores into actionable information to help launch investigations
Claims Investigation Platform
- Expedites the investigation process by providing immediate access to insights based on location, associations, claims filing trends and usage of CPT, ICD codes and modifiers
- Helps quickly qualify leads that result in maximum savings
- Helps catch phantom clinics by displaying pictures of provider practice locations through the platform directly
Workflow Management System
- Manage workflow within the SIU
- Process cases for providers and beneficiaries
- Add notifications, reminders and comments to cases
- Share any screen with other SIU members to enhance collaboration
- Customize roles and permissions
Automatically identifies new fraud, waste and abuse schemes as they appear.
Provides intelligence and risk analysis before claims are paid.
Prioritization of Suspicious Claims
Prioritizes suspicious claims based on risk scores and dollar amounts to maximize savings.
Enables fraud analysts and investigators to find better leads more frequently.
Works with existing analysis techniques and can integrate other intelligence feeds.
Adapts to changes in coding terminologies and international coding systems.