In the healthcare and HMO space, the PARALLAXperspective can help prevent losses due to fraud, waste and abuse, driving down combined ratios and ultimately enabling lower healthcare premiums for consumers overall. This powerful anti-fraud solution identifies questionable claims that are difficult for human claims analysts to detect, particularly as the volume of claims increases.
The use of an automated flagging and detection system ensures that questionable claims are flagged before payment is made. Each claim is run through a database of rules and filters to identify myriad patterns and outlier claims that would be almost impossible to detect with manual analysis alone. In short, questionable claims that might not otherwise stand out in isolation are identified before payout.
This has a three-fold benefit for insurance companies:
1. Reducing claims analysts work load;
2. Allowing claims personnel to focus only on non-conforming claims; and
3. Avoiding payment for non-conforming or improper claims.