Claims have wealth of information in them

Smart leaders are leveraging HSI Analytics for insights and to identify targeted interventions

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    what explain this delta
    • Provider rate increase
    • Case mix change
    • Claim volume change
    • Member risk profile change
    year’s spend
    year’s spend

    As a Payer CFO, do you know the reasons behind medical spend changes

    – what are the components and precise contribution of each component

    HSI’s claim analytics helps provide insights to CFOs to get a deeper understanding of cost trends

    Quantify precisely the impact of membership changes, provider rate increases, case mix changes and other variables on medical spend

    Identify target areas to manage costs and bend the cost curve

    As a Payer CMO, get greater insights into utilization trends and drive better outcomes

    • HSI’s claim analytics gives Medical Management team insights into service level utilization and trends – normalized for reimbursement rate changes
    • Identify services that are seeing above trend spike in utilization
    • Derive better ROI from UM resources – better targeting and better outcomes

    Clients and partners that trust our capabilities


    Synergen Health deployed AI driven, Underpayment Analytics from Health Sigma. The solution used readily available 835s and successfully identified significant underpayments very efficiently. The mapping of underpayment to contracts further made the appeals process easier.

    Sunil Konda

    Vice President, Product at SYNERGEN Health

    CFMC leveraged Health Sigma’s proprietary AI Analytics Platform for claims analytics and contract benchmarking. Health Sigma played a key role in improving CFMC’s overall financial performance

    Anthony Gutierrez

    Head of Revenue Cycle, Community First Medical Center