Combating Healthcare Fraud with Data and Analytics
Improve provider network data integrity, eliminate FWA and maximize performance.
18 percent of the GDP in the U.S, which is $3.65 trillion, is spent on healthcare. Every year at least $300 billion is lost to fraud, waste, and abuse (FWA).
In a world where Medicare processes more than 4.5 million claims a day, payer organizations need to become efficient, enable robust fraud detection engines and identify waste.
Mandated processing efficiencies, overlooked claims, staff shortages, and disparate record systems create opportunities for fraud, waste, and abuse (FWA). With the current Manual or rule-based engines mounted on legacy systems, processes tend to be slow, workforce-dependent, less accurate, and error-prone.
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Organizations consume an average of 240 human hours updating the rules of a legacy solution in a lifetime. Up to 40 percent of alerts investigated are false positives, at a minimum investigation cost of $7,500 each – Tim McBride, Director of Healthcare Product Development and Innovation at MasterCard.
Saxon’s intelligent healthcare solution is designed for hospitals and health systems, payers, and insurers. Our intelligent data services cater to emerging fraud patterns and compliance regulations.
We are helping organizations improve provider network integrity and performance while reducing human resources, FWA risk and enhancing provider network data quality.
With the power of artificial intelligence, automated anomaly detection, and continuous machine learning, organizations can automate data insights that enable real-time provider data management and network optimization while reducing costs.
Forget rip and replace legacy healthcare systems; we provide easy implementation and over-the-top solutions.
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A comprehensive end to end solution
Improve provider network integrity and performance with real-time insights
- Automated provider data management
- Automated provider integrity
- Automated provider credentialing
Detect, prevent and recover healthcare fraud, waste, and abuse
- Automated detection and prevention
- Automated detection and recovery
Align claims submissions, optimize payment integrity and revenue cycle performance
- Automated denials prevention
- Automated claims editing
- Medicare reconciliation reports
- Unfunded care recovery
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time and cost
and data security