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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 Curacel?

Curacel's innovative platform, powered by artificial intelligence, enables insurance companies to monitor fraudulent activities and streamline claim processing with efficiency. It simplifies the collection of claims from providers while offering automatic verification capabilities. Through Curacel Detection, insurers can effectively pinpoint and mitigate instances of fraud, waste, and abuse throughout the claims process. By gathering claims from providers, the system actively works to prevent any potential losses due to these issues. Our analysis of the Health Insurance sector revealed that significant value loss often occurs during the claims process, which remains largely manual and vulnerable to various forms of exploitation. The implementation of our AI-enhanced solution significantly minimizes waste, enhances efficiency for insurers, and reveals previously obscured value opportunities. Ravel insurance distinguishes itself by offering on-demand policies that provide coverage for short durations, catering to the needs of policyholders and insured parties alike, both of whom seek prompt and precise claim resolutions. By focusing on speed and accuracy, Ravel ensures a smoother experience for all involved.

Media

Media

Integrations Supported

Additional information not provided

Integrations Supported

Additional information not provided

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

Curacel

Company Location

Nigeria

Company Website

www.curacel.co

Categories and Features

Categories and Features

Claims Processing

Adjustor Management
Case Management
Claim Resolution Tracking
Co-Pay & Deductible Tracking
Compliance Management
Customer Management
Electronic Claims
Forms Management
Paper-Based Claims
Payor Management
Policy Administration

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