Fraud Detection

With the abilities of automation and machine learning combined together, auditing the medical claim & billable code is easier than ever. Let Artificial Intelligence ensure there are no discrepancies in the clinical code.

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How we solve it?

Payors spend several days to weeks assessing a claim, but the insurance business is still affected by upcoding of procedures and other abuse attempts. Clinical NLP provides a mechanism to reduce potential issues of fraud and abuse in medical coding. Built upon a health information technology platform, clinical NLP powered applications can review the codes and documentation in the claims that are based upon standard coding principles and guidelines. It assists payors in reviewing codes and supportive documentation required for compliant & accurate claims.

Customer Challenges

Manually detecting up coded cases by strong evidence in documents for corresponding codes.

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Clinical NLP as a service

Convert Unstructured clinical text to structured information, mapped with ICD 10 ontologies.

Our Value ADD

  • Develop AI/ML Models, Customizations
  • Last Mile application to accurately and quickly identify coding fraud instances

Customer Wins

Identify instances of fraud .

How it Works?

fraud-detection-use-case

Want to know more about our Clinical NLP APIs?