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Medical overtreatment detection
Helps working through excessive claims via machine learning solution to reduce claims payouts up to 4.5%
less claims payouts
%
4
4
,5
,5
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We understand how important that is to comply with insurance rules and medical standards. This is how the insurance policy was originally underwritten and should be executed.
Thus, we have a solution which helps Insurers to control leakage, overtreatment and fraud coming from clinics or Insureds.
1 200+ rules/algorithms
Identify concrete suspicious services. Based on European clinical guidelines, standards and protocols
Product features
Interface for med. experts
Service pricing model
Analytics
User-friendly interface integrated into the client business process
Installation fee – 0. Success fee based service payments
Advanced health analytics for further management decisions
10 mio
combinations checked by the system
Regular updates
+30-50 new algorithms per month in addition to customized rules based on client requirements
up to
%
Problem
Solution
Overtreatment level in clinics worldwide
Insurance companies able to thoroughly check only part of bills received
COVID worthened the overtreatment growth
Plug-and-play
AI-software for Health overtreatment and claims leakage detection
AI-software for Health overtreatment and claims leakage detection
Romania Business case
We’ve been given a dataset for 2 months period of medical services reimbursed by one of the big Health Insurers.
Case study
Health. Advanced Health Analytics
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