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Medical overtreatment detection

Helps working through excessive claims via machine learning solution to reduce claims payouts up to 4.5%

,5

,5

4

4

%

less claims payouts

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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.

Product features

Interface for med. experts
User-friendly interface integrated into the client business process
Service pricing model
Installation fee – 0. Success fee based service payments
Analytics
Advanced health analytics for further management decisions
+30-50 new algorithms per month in addition to customized rules based on client requirements
Regular updates
combinations checked by the system
10 mio
Identify concrete suspicious services. Based on European clinical guidelines, standards and protocols
1 200+ rules/algorithms

Problem

Solution

Plug-and-play
AI-software for Health overtreatment and claims leakage detection
Overtreatment level in clinics worldwide
Insurance companies able to thoroughly check only part of bills received
COVID worthened the overtreatment growth
%
up to

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24 h

We’ve been given a dataset for 2 months period of medical services reimbursed by one of the big Health Insurers.

Case study

Romania Business case
We’ve been given a dataset for 2 months period of medical services reimbursed by one of the big Health Insurers.
Romania Business case