PostShield contains powerful fraud rules and algorithms developed by industry experts who understand the essentials of fraud detection and prevention. With an estimated 3-10% of claims dollars misappropriated due to Fraud, Waste, and Abuse, it is essential to monitor claims from every phase of the claim cycle. PreShield and PostShield work together to improve the success of your FWA efforts. PostShield guarantees:
- Powerful algorithms producing smarter results and less false positives
- Rules uniquely designed to catch suspicious billing patterns, coding errors, policy and contract violations, collusion, ineligible providers, and ineligible members
- Improve ROI by identifying actual fraud cases
- A system that does not require technologically advanced users and can be operated by any staff member
- Intuitive workflow and simple design
- Intelligence driven results continuously advancing the rules and predictive analytics incorporated into the FWAShield platform
Additional HCFS Products and Services
FWAShield utilizes unique and proprietary data sources to maximize Return on Investment (ROI) and achieve superior results.
Reduce dollars lost by preventing ineligible claims to be paid
Identifies prescription drugs improperly billed based on company policies and guidelines.
Runs real-time queries and complex pattern reports from loaded data.
Automates Case Management, including reporting, tracking, and communications.
Analyzes claims data, develops cases, detects systemic weaknesses, and more.