Medical Payment Integrity

As the front line in insurance claim processing, we know Claim Assessors make hundreds of split-second decisions each day.

Our platform provides an early warning mechanism to filter out erroneous and incomplete claims. As well as highlighting those that form part of previously detected patterns.

This allows you to benefit from the full insight and analytic power of the investigative teams and data analysts. Supported by our custom designed Machine Learning algorithms.

Our platform offers a single point of integration with your in-house systems.

Feedback generated in real-time as part of data extraction can be automatically fed into your existing systems. Results in plain English are incorporated into existing user interfaces and passed through existing processing pipelines.

The platform can be deployed on your premises or in the cloud. For an on-premise installation, we supply user management endpoints and a deployment within your firewall.

All communication is encrypted as is data at rest. Third-party write-only logging comes as standard.

The investigator’s workflow starts with the case inbox. Cases are automatically generated collections of claims with context.

A case might focus around a practitioner who performs an unusually high number of appendectomies. Another case might centre on a hospital that consistently bills more for MRI scans than expected. The cases are adjusted for specialisations, and geographic and demographic differences.

Each case can be visualised in its entirety and drilled down all the way to line item level.

Once the investigation is complete, feedback is collated and sent to the Claim Assessor tools for use in early detection.

A comprehensive data audit is essential to a) obtain an independent assessment of in-house claim processing streams and b) to identify strengths / weaknesses that can be leveraged or improved upon.

An independent audit allows an organisation to direct their focus into processes, data and workflows where sometimes even small changes and improvements can yield considerable commercial benefits.

Following the audit, Kirontech will supply a full list of informed recommendations. At the full discretion of the customer, an audit is a natural stepping stone for further collaboration or an on-going commercial relationship.

The efficiency of Data Analysis is greatly enhanced when the data is audited, encoded and enriched by the latest reference data and in accordance with the up-to-date coding standards.

As a result, your internal data analytics teams, assisted by Kirontech's data scientists, will be able to extract value, derive sound conclusions and establish patterns that previously would have been invisible or obscured by simple data noise.

The experience of our in-house experts further helps you leverage your in-house talent and to better understand the data you hold.