Stop Improper Claims Real-Time, Before They’re Paid




With healthcare fraud, waste, abuse, and error (FWAE) taking on new and innovative methods every day, traditional investigations can’t keep up — that’s where PreShield® comes in. PreShield® benefits Payment Integrity, Special Investigation Units, Cost Containment and other departments to combat FWAE.
PreShield® is a pre-payment detection system focused on the most viable and prospective suspicious claims using real time data. It uniquely leverages both historical paid claims and current prepay claims to maximize detection and prevention.
Designed to work directly with Medical Record Retrieval Services, NLP, PostShield® , QueryShield®, and CaseShield®, the integrated modules work together to improve the success of your Payment Integrity, Cost Containment and SIU teams and increase your ROI.
Product Features

Tailored daily feeds based on claim attributes, staff availability, staff expertise, company initiative, and regulatory alerts and guidance

Increased ROI by preventing fraudulent claims before they are paid

Reduced false positives for more efficient investigations of tangible suspicious claims

Concise and detailed alerts that provide reference points and context on complex fraud topics and schemes
Download the Full PreShield® Product Feature List
Explore Our Products:
Stay up to date with the latest insights on healthcare payment integrity, cost containment, and FWAE on our blog.
Achoo! Respiratory Tests to the Rescue!
Ahhh, Spring is in the air and that means the pollen is too. That familiar “achoo!” echoing might be more than just a fleeting reaction. For many, it’s a persistent reminder of the pollen power that’s currently dominating the atmosphere.…
Skin Deep Deception: Topical Prescription Trends
Prescription topical medications play a vital role in managing various skin conditions. Topical medications are widely available for acne treatments, anti-inflammatory, antifungals, antibiotics, pain relievers and more. However, the lucrative nature of these products has unfortunately created opportunities for improper billing.…
The Critical Need for Prepay Fraud Detection in Healthcare, Chemodenervation & More
The healthcare industry is a prime target for fraud, with billions of dollars lost annually due to inappropriate claims. While post-payment detection methods have been the traditional approach, they often fall short. The ‘pay and chase’ method can lead to…
Recharged and Ready for New Schemes: Hit the Ground Running in 2025
Hello January! The holiday decorations have been packed away, the eggnog jug is long empty, and the lingering scent of pine needles is fading fast. Let’s be honest, after weeks of festive cheer, indulgent meals and leisurely mornings, it was…
Going into 2025 – A Balancing Act of Technology, Economy, and Patient Care
As we rapidly approach the end of 2024, we reflect on some changes and adaptations in the healthcare industry. The industry faced both challenges and opportunities. We witnessed a convergence of factors shaping the future of health insurance – from…
Sniffling Your Way Through the Season: Arm Yourself with a Vaccine
Is it a cold? Is it the flu? Or is it just your body’s way of saying, “Enough with the pumpkin spice, already?” Whether we like it or not, cold and flu season is upon us! According to the Center…
Chemodenervation: Injecting Payor Requirements Into the Mix
Chemodenervation involves the use of chemical agents to temporarily or permanently block nerve signals, paralyzing the targeted muscles. The most commonly known chemical agent is botulinum toxin (Botox), which is typically used for cosmetic purposes. It is also approved for…
Beyond the Stigma: Overdose Awareness and Emergency Treatments
International Overdose Awareness Day (IOAD), which was just held on August 31, is an annual global event dedicated to raising awareness about overdose, promoting prevention, and advocating for treatment and support services. Overdose is a serious public health issue that…
Spinal Injection Billing & Coding: A Pain in the Neck?
Neck and back pain are a common problem in the US. According to a 2019 study by the CDC and the National Center for Health Statistics, 39.0% of adults reported experiencing back pain in the last 3 months [1]. Back…
Investing in Talent Pays Off, From Intern to FWA Investigator
Standing on the cusp of my final nursing semester, I felt uncertainty. Unlike my classmates, their futures neatly mapped out with dream hospital placements, I had no clear path. My previous clinical internships, while valuable in direct patient care, hadn’t…