Predicting and preventing fraud, waste and abuse for healthcare payers

CGI ProperPay is configurable to an organization’s specific business rules and reimbursement methodologies. Its predictive analytics, workflow management, rules management and global best practices are available in the secure Microsoft Azure Cloud for even greater elasticity and power and include:

  • Advanced algorithms to predict hidden patterns and anomalies within the entire claims data universe to identify claims with high potential for recovery. This analysis allows staff to easily work on these claims through a series of edits. Microsoft’s Cortana Intelligence Suite is used to harness machine learning, perceptual intelligence and the cloud for predictive healthcare. As models are exposed to new data, it is incorporated to produce even more reliable, repeatable results.

  • Analytics to prevent fraudulent activity and keep patients safer, allowing staff to easily identify patterns and research claims as well as audit data through a series of views and dashboards.

  • Security to protect health information. The Azure Cloud meets a broad set of international and industry-specific compliance standards, such as ISO 27001, HIPAA1 , FedRAMP2, SOC 1 and SOC 2. Its HIPAA Business Associate Agreement (BAA) stipulates adherence to HIPAA’s security and privacy provisions.

  • Technology to identify, stop and recover improper payments to preserve healthcare funds and revenue. Recovering a greater number of improper payments makes funds available to improve patient care. Business user-friendly features also free up valuable IT resources for other priorities.

CGI ProperPay