What it’s best to know:

• Healthcare Fraud Protect (HCFS), a number one supplier of fraud, waste, abuse and error (FWAE) safety options for the medical insurance market, as we speak launched FWA360Leads, a brand new product that routinely identifies and prioritizes FWA leads based mostly on order of significance and severity of the affect.
• The HCFS PlatformTM is the spine of many main well being insurers' FWA and fee integrity methods – delivering hundreds of thousands of {dollars} in financial savings, recoveries and prevented losses yearly.

Revolutionizing medical insurance with AI-powered fraud detection

Well being insurers face useful resource and time constraints in figuring out, qualifying and accepting new leads for fraud, waste and abuse instances, whether or not by way of pre- or post-assessment. To deal with this problem, HCFS launched FWA360LeadsTM as an automatic resolution throughout the healthcare plan workflow, seamlessly built-in into HCFS's FWA Precision EngineTM. This revolutionary instrument makes use of AI fashions, together with machine studying, to detect, current, assess and settle for leads, optimizing the method and delivering a number of enterprise advantages:

1. Enhanced lead worth by combining synthetic intelligence with HCFS's in depth library of over 1,000 alerts.

2. Discount of false positives and improved precision and accuracy by way of machine studying.

3. Elevated operational effectivity, resulting in useful resource financial savings.

The system proactively identifies and prioritizes high-risk instances by way of early detection in prepayment situations, and gives actionable data for speedy responses, comparable to prepayment measures, supplier coaching, and case prioritization.

“We’re thrilled that early well being insurer customers of FWA360LeadsTM have reported excessive ROI from the product,” mentioned Karen Weintraub, EVP, HCFS. “They’re now capable of eradicate tedious guide evaluation and determine new necessary leads that they’d in any other case have missed. This product represents the continued evolution of HCFS, as we all the time attempt to leverage the newest technological improvements to guard our clients from FWA and supply them with hundreds of thousands in financial savings that they’d in any other case by no means recoup.