Only 2% of claims have overpayments. Audits rarely identify all cases
Traditional approaches merely mimic adjudication rules
It is highly resource-intensive and only provides static analysis
How AI makes a difference
for Payment Integrity
programs learn and
evolve as opposed to
Reduces the use of
such as nurses
Amplify your payment integrity
program outcomes with AI
No replication of your processing rules.
No random sampling. AI can analyze every claim.
We can get started with just your claims data.
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.
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