PrecisionGx AI Engine is built natively on and for health insurance claims data.
Data
Medical and pharmacy claims, enrollment, provider, and other ancillary data sets are loaded and transformed by our proprietary engine.
Mapping
Existing policies, pricing, and rule information are inferred from plan data and relevant rules and regulations from outside sources are loaded.
Modeling
Payments are modeled against rules, risk, and billing patterns to identify potential overpayments, anomalies, and coordination issues.
Intelligence
Identified overpayments and other intelligence are transmitted to recovery resources. Results feedback into the engine for optimization.
Why automate?
More savings, more recoveries, for less
35
35
detection system improvement
6
6
amount recovered per claim
50
50
reduction in vendor fees
14
14
in savings per 1M members
We serve organizations across the healthcare ecosystem.
Where do you fit?
Payers
Automating premium and payment integrity for payers, identifying an average of $14M in potential savings per million covered lives.
Audit & Recovery Vendors
Automating data mining, audit and recovery efforts, increasing per audit recoveries by as much as 6x and improving precision of detection by more than 35%.
Health Systems
Using claims intelligence to optimize revenue management for systems by ensuring proper payments, reducing administrative time and overhead.