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Insurance-Workmens comp

AQUILA : Insurance Fraud Detection Solution

Overview

Our Provider Fraud discovery and red flag detection solution is built by incorporating 20+ use cases like up coding, unbundling, cluster billing etc. algorithms with the use of both internal and external data. It uses the medical bills and other claim related data to discover fraudulent activities and marks them as red flag bills.

KEY FEATURES

  • Leveraging BIG DATA for ingesting internal & external data
  • Flagging more than 20 provider use cases
  • Providing Google like search capabilities
  • Providing export/download features to provide evidence
  • Provide rich analytics to visualize the fraud trends
  • Provides alerts for set rules for to watch for a provider bill
  • Patterns of billing, relationship between different parties
  • Ingesting external data for overview of the provider
  • Getting alerts from FBI, NICB etc.

BENEFITS

  • SIU can focus on investigating the fraudulent case rather than spending time looking for one
  • More fraud case can be closed
  • Dependency on IT is reduced by more than 80%
  • Pre-built rules engine that reduces implementation time.
  • Allows modular build so can customize easily.
  • Solution incorporates many security features like network segmentation, encryption of hard drive etc.
  • Provides casework collaboration.
  • Solution is HIPPA compliant
  • Tracks and logs all searches for internal audit

For more information on Aquila, the smart eagle that addresses fraud, please contact  This email address is being protected from spambots. You need JavaScript enabled to view it.

 

Contact Us

SoftSol Inc.
46755 Fremont Blvd.,
Fremont, CA 94538

Phone: 510-824-2000
Fax: 510-824-2098
E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 

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