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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 Facio?

Facio offers AI-enhanced software infrastructure specifically designed for specialty insurance organizations, including Managing General Agents (MGAs). Our cutting-edge platform, FacioMGA, supports the entire lifecycle of policies, which includes steps such as submission intake, risk assessment, underwriting, quoting, binding, policy issuance, endorsements, billing, commissions, compliance, reporting, renewals, and various integrations. Clients enjoy the flexibility to tailor products, rating criteria, eligibility requirements, workflows, documents, and permissions without the necessity of reengineering their technology for each program they implement. Furthermore, Facio supplies independent services that assist with surplus-lines tax and fee calculations, SIC/NAICS classification, sanctions screening, actuarial functions, and automated processes for addressing carrier declinations. Our innovative Org2vec technology creates a memory system founded on evidence that connects policies, contracts, financial records, assets, suppliers, cybersecurity protocols, and operational data. Alongside this, Facio Eigen offers a zero-trust control framework that rigorously enforces permissions, rules, approvals, and audit trails for decisions and actions enhanced by AI. Utilizing these sophisticated technologies allows organizations to optimize their workflows, improve compliance measures, and ultimately drive better business outcomes. The integration of these tools positions us as leaders in enabling a more efficient and compliant insurance sector.

Media

Media

No images available

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 Version
Free Trial Offered?

Pricing Information

$65/mo./user + cloud
Free Version
Free Trial Offered?

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

Facio

Date Founded

1600

Company Location

United States

Company Website

www.facio.io

Categories and Features

Categories and Features

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