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.

Contact Us

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