Data Mining: High Knowledge, High Tech
Our tech-enabled services accurately identify inappropriate payments by leveraging a powerful AI engine and payment integrity industry experts, supported by Alivia’s configurable Payer Analytics Platform. Other vendors provide legacy business rule catalogs, costly labor models, manual and error-prone analysis, fewer recoveries and high overhead, and low confidence and high cost.
Why Alivia? Additional 15-25% Recoveries
- We provide automated AI claims review and interrogation
- We utilize classification and prediction to update learning models constantly
- We deliver more recoveries and less overhead
- We provide high confidence with low costs
FOCUS AREAS:
- Duplicate Payments
- Contractual Discrepancies & Inconsistencies
- Conflicts with Health Plan Payment Policies, CMS Guidelines, State Rules, etc.
- Unit / Relative Code Discrepancies
- Upcoding and Unbundling
- Outlier Detection
- Anomalous Provider Billing Patterns
- High-Cost Drugs
- Retro-Termination of Coverage
- System Pricing Errors
- Stop Loss and Long Stays
- DRG
- Charge Master
AI ASSIST FUNCTIONS
Alivia’s AI capabilities extend beyond traditional data analysis, providing predictive modeling, real-time decision support, and automated workflows that enhance operational effectiveness. By leveraging AI, we help organizations avoid fraud, optimize their payment processes, and confidently make data-driven decisions.
Alivia Healthcare LLMs
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