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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 DRILLER?

DRILLER is a cutting-edge analytics platform aimed at transforming the digitization and comprehensive analysis of insurance portfolios by effectively managing both structured and unstructured data. This solution significantly improves the understanding of the portfolio's resilience and the nature of claims. By utilizing its advanced features, it accelerates reserve releases, leading to reduced requirements for solvency capital and minimized capital costs. The innovative tool leverages artificial intelligence to perform in-depth evaluations of portfolios and claims, while also predicting potential adverse developments in claims through a sophisticated severity scoring mechanism. Furthermore, it enables the prompt identification of claims that may be either under-reserved or over-reserved. Users gain access to fully searchable documentation and claims, coupled with valuable insights into the structure of the portfolio. The tool excels in recognizing various elements such as characters, numbers, and sentiment while efficiently categorizing documents and identifying specific characteristics of claims. It also simplifies the process of reviewing and prioritizing critical claims that require urgent attention, all supported by automated analysis across the entire portfolio, thereby enhancing both operational efficiency and informed decision-making. In addition, the platform continually evolves to incorporate user feedback, ensuring it remains relevant and effective in meeting the dynamic needs of the insurance industry.

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

DGTAL

Company Location

Germany

Company Website

dgtal.io/products/

Categories and Features

Categories and Features

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