Insurance › Claims Management › Fraud Detection (Claims)

Healthcare Fraud Shield

AI and rules-based SIU and FWA suite for health claims.

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Overview

Healthcare Fraud Shield offers an SIU and fraud, waste and abuse suite for health claims that combines AI with rules. It supports pre- and post-payment detection and investigation across the claims cycle.

The platform serves health plans and payer SIU teams that need a comprehensive, configurable detection and case-management toolkit.

Key Features

+ AI and rules-based detection
+ Health-claims FWA suite
+ SIU case management
+ Pre- and post-payment review
+ Provider and member analytics
+ Reporting and dashboards

Integrations

Open APICore claims systems

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