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Workers' Compensation Provider Risk Rating Software

The most accurate, holistic and accurate view of risk posed by providers to your organization


Adopt a culture of 'Proactive Claims Management' using suite of products


Improve tactical, operational and strategic decision with predictive power


Tangible benefits - 10 to 15% in efficiency gains; 15- 20% by preventing fraud, abuse & waste; Increased customer satisfaction


Quick deployment and easy integration with your existing claims management systems through a library of APIsIt's easy.

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Provider Fraud Detection
Get the most accurate and actionable intelligence on providers indulging in FAW (Fraud, Abuse & Waste)

        -  Accurate algorithms to flag a wide variety of billing anomalies well beyond the capabilities of                       most claims management systems.

        - A 3-Digit risk rating denotes the magnitude  and sophistication of risk being posed by a provider.

        - Flexibility to assign the weightages to various use cases giving you a customized rating                                    model, that is best suited to your environment.

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Flags Multiple Types of Billing Anomalies  analyzes every billing transaction coming into your system. And uses proprietary algorithms to flag Duplicate Bills, Excessively Priced Bills, Providers exhibiting a high degree of Accelerated Billing, Split Billing, ICD & CPT Anomalies, Physician Specialty & CPT mismatches, Rate of Denied Invoices, LEIE (List of Excluded Individuals and Entities) providers and a few others.

Through an easy workflow, the flagged transactions are routed to auditors for confirmation. True Positives and False Positives are further fed back into machine learning algorithms to build the continuous loop for constant improvement in accuracies.

An Intelligent 3-Digit Risk Score

All the flagged provider transactions are consolidated to build the 'Provider Risk Rating Model' - a 3-Digit Score, which indicates the magnitude and extent of fraud or abuse being perpetuated by a provider.


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Claimant Fraud

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Insightful Dashboard  ranks the providers on a dashboard to let you focus on top few. The filter options in the dashboards lets you view the risky providers as per type (Lab, Physician, Facility etc.), Score (Above 600 only), Location, Specialty etc.


Provider Risk Score helps you prioritize your investigation. It also gives you precise information about the methodology being deployed by providers to make illegitimate gains. And lets you drill down the score to the most granular level of transaction.

Provider Fraud

Configure Score-based Notifications let's you configure notifications as per the severity of the provider risk score. You may configure the schedule of such notifications along with designated personnel too.


The triggered notifications are posted to Auditor's queues or inboxes to let your team initiate the necessary investigation or action without losing time.


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route-fifty-lead-image.jpg Predictive Suite use highly sophisticated AI and Deep Learning Models to make accurate predictions of critical claims parameters. Models ingest structured as well as unstructured data (like Adjuster's Notes), run them through a proprietary statistical models to give the final inputs.


In line with dynamic nature of insurance business, the solutions are trained to monitor the hit ratio. And use this data to self improvise over a period of time - further entrenching into the core of your claims operation.




Interested in augmenting your business with ?

Request A Free Demo 

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