The Automated Healthcare Risk
Management System is a real-time
Software as a Service application which interfaces and assists investigators, law
enforcement and risk management analysts by focusing their efforts on the highest risk and highest value healthcare payments. The
system's Risk Management design utilizes real-time Predictive Models, a Provider
Cost Index, Edit Analytics, Strategy Management, a Managed Learning Environment, Contact Management, Forensic GUI,
Case Management and
Reporting System for individually targeting, identifying and preventing fraud, abuse, waste and errors prior to
payment. The Automated Healthcare Risk
Management System analyzes hundreds of millions of transactions and automatically takes actions such as declining or queuing a suspect
payment. Claim
payment risk is optimally prioritized through a Managed Learning environment, from high risk to low risk for efficient resolution by investigators.