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What is Shift Payment Integrity?

Shift’s Payment Integrity presents a sophisticated AI-enhanced solution specifically designed for health plans, focusing on improving accuracy while reducing costs in the claims payment process. This cutting-edge tool functions effectively in both the pre-payment and post-payment stages, allowing plan administrators to detect potential problems early and recover overpayments with ease. Key features include dynamic claims editing with up-to-date rules, AI-assisted examinations of medical records, identification of anomalies, as well as fraud, waste, and abuse, along with the incorporation of external data for a more thorough analysis. The system is built to adapt to evolving policies and guidelines, featuring automated policy evaluations and an edit logic workbench that permits health plans to test ideas before full implementation. Furthermore, it offers clear flags and alerts that inform reviewers of the reasons behind claim flagging, speeds up document reviews by highlighting crucial sections of records, and uses data mining techniques to reveal emerging patterns. In addition, the platform provides a unified case management interface that optimizes investigative workflows, driving greater operational efficiency for health plans. Ultimately, this innovative solution empowers health plans to navigate the complexities of the claims process more effectively.

What is Cluda?

Cluda represents a cutting-edge platform that utilizes artificial intelligence to streamline the analysis, comparison, and automation of insurance policy renewals, empowering brokers and insurance experts to refine their back-office operations by eliminating manual checks, reducing error risks, and speeding up vital processes. Through the use of intelligent document ingestion, Cluda efficiently uploads and standardizes complex policy documents across various formats, such as PDF and Word, while incorporating advanced optical character recognition (OCR) and AI to automatically extract essential data and clauses. Additionally, the platform creates clear side-by-side policy comparisons that highlight differences in coverage, exclusions, and terms, complete with direct links to the original documents for straightforward verification, thereby reducing the risk of missing changes and ensuring adherence to compliance standards. Furthermore, Cluda arranges the analyzed data into tailored renewal reports that align with specific firm templates, drastically cutting down the time required for manual reporting and enhancing client communication. To further enrich the user experience, it provides an AI-driven assistant that addresses coverage inquiries and offers valuable policy insights, ultimately strengthening the decision-making processes for insurance professionals. This combination of features positions Cluda as an essential tool in modern insurance practices, ensuring efficiency and accuracy in a rapidly evolving industry.

Media

Media

Integrations Supported

Microsoft Word

Integrations Supported

Microsoft Word

API Availability

Has API

API Availability

Has API

Pricing Information

Pricing not provided.
Free Trial Offered?
Free Version

Pricing Information

Pricing not provided.
Free Trial Offered?
Free Version

Supported Platforms

SaaS
Android
iPhone
iPad
Windows
Mac
On-Prem
Chromebook
Linux

Supported Platforms

SaaS
Android
iPhone
iPad
Windows
Mac
On-Prem
Chromebook
Linux

Customer Service / Support

Standard Support
24 Hour Support
Web-Based Support

Customer Service / Support

Standard Support
24 Hour Support
Web-Based Support

Training Options

Documentation Hub
Webinars
Online Training
On-Site Training

Training Options

Documentation Hub
Webinars
Online Training
On-Site Training

Company Facts

Organization Name

Shift Technology

Date Founded

2013

Company Location

France

Company Website

www.shift-technology.com/products/payment-integrity

Company Facts

Organization Name

Cluda

Date Founded

2024

Company Location

United States

Company Website

www.cluda.ai/

Categories and Features

Categories and Features

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