Tackling Fraud, Waste and Abuse (FWA) in healthcare insurance
Using an intelligent rules engine, Curacel's Platform helps Health Insurers realize massive time and cost savings
A state-of-the-art software platform that detects fraud and errors in customer data, while fast-tracking claims processing for both health insurers and providers.
Suite Core Modules
When claims data enters the platform, each claim passes through an extensive data validation process powered by eClaims engine, producing risk scoring metrics and pinpointing FWA in each claim.
eClaims comprises simple rules like age and gender as well as extensive machine learning algorithms that consider the full treatment histories.
Once individual claims are validated and sanitized, eVerify sniffs its way through the entire database looking for behavioural patterns, collusion networks, and inefficiencies such as upcoding.
The unsupervised graph based sweeps learn and adapt to new relevant patterns, spotting complicated patterns that are not visible to unaided human eye.
For top level managers, having the right tools to overview and monitor the business is paramount. eMeasure allows you to summarise and quickly produce management-level reports of your data.
With eMeasure, you can narrow down on metrics and statistics such as processed claims, most common violations, total riskiness and estimated FWA figures.
REALTIME CLAIMS VALIDATION
It provides the main integration point for the customer. The customer can leverage the full power of the Curacel Platform using simple REST/json calls.
With simple and scalable hardware configurations, the software can handle both realtime and bulk loads depending on the use case.
SPOT FWA IN REAL TIME
Prevention is better than cure. As claims are submitted in real time, the Platform responds with live alerts. The alerts can easily be integrated into existing workflows to ensure you capture inefficiencies even before they arise.
The types of alerts range from simple age/gender based rules to complex AI driven pattern searches.
To protect customer data, the Platform can be deployed on premises or VPN in secure cloud. All certificates are supplied by the customer, and the customer retains full control of user access management and application tokens.
We work with your data in your infrastructure - your data never leaves your control.
We currently power claims processing for the top HMO's in Nigeria and Ghana.