AQUILA : Insurance Fraud Detection Solution
Our Provider Fraud discovery and red flag detection solution is built by incorporating 20+ use cases like up coding, unbundling, cluster billing etc. algorithms with the use of both internal and external data. It uses the medical bills and other claim related data to discover fraudulent activities and marks them as red flag bills.
- Leveraging BIG DATA for ingesting internal & external data
- Flagging more than 20 provider use cases
- Providing Google like search capabilities
- Providing export/download features to provide evidence
- Provide rich analytics to visualize the fraud trends
- Provides alerts for set rules for to watch for a provider bill
- Patterns of billing, relationship between different parties
- Ingesting external data for overview of the provider
- Getting alerts from FBI, NICB etc.
- SIU can focus on investigating the fraudulent case rather than spending time looking for one
- More fraud case can be closed
- Dependency on IT is reduced by more than 80%
- Pre-built rules engine that reduces implementation time.
- Allows modular build so can customize easily.
- Solution incorporates many security features like network segmentation, encryption of hard drive etc.
- Provides casework collaboration.
- Solution is HIPPA compliant
- Tracks and logs all searches for internal audit