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
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