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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 MediConCen?

We are excited to unveil a groundbreaking automated insurance claim system that incorporates cutting-edge blockchain technology. The claims process is a pivotal moment for insurance companies, and our solution has been carefully designed to enhance efficiency for both policyholders and insurers, guaranteeing unmatched accuracy and swift processing—from initial assessments to final disbursements. MediConCen leads the charge in insurance technology by utilizing Hyperledger Fabric blockchain to revolutionize the claims experience for insurance organizations, medical networks, and healthcare providers alike. Our platform empowers claims adjusters with advanced AI algorithms and decision-making tools that quickly detect fraudulent claims while ensuring that valid claims are processed promptly, thus optimizing claim management and boosting operational effectiveness. Furthermore, we deliver valuable analytics that improve underwriting practices and inspire product development, equipping stakeholders with essential insights to thrive in a competitive environment. This holistic strategy not only simplifies the claims process but also cultivates trust and dependability within the insurance sector, ultimately benefiting all parties involved. By embracing innovation, we are redefining the future of insurance claims.

Media

Media

Integrations Supported

Hyperledger Fabric
WhatsApp

Integrations Supported

Hyperledger Fabric
WhatsApp

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

MediConCen

Company Location

China

Company Website

www.mediconcen.com.hk/

Categories and Features

Categories and Features

Insurance Claims Management

CRM
Claims tracking
Customer portal
Document management
EDI data exchange integrations
Electronic claims
Fraud management
Reporting

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