PrecisionGx helps audit, recovery and other third-party vendors automate audit and recovery efforts, data mining processes, and fraud, waste and abuse detection using AI-driven claims intelligence technology, delivering the tools they need to compete and win.
Overpayment & recovery
Our goal is to help each vendor recover every dollar possible. Our engine helps vendors automate existing overpayment detection systems to stop profit leakage, improve performance and reduce administrative spend. A learning system, our engine tracks all analysis outputs and reporting, including provider engagements such as concept approvals/disapprovals, remittances, payment reconciliations and more. Today the vendors who leverage our technology are realizing an increase in per audit recoveries up to 6X while significantly reducing unnecessary auditing.
Our engine complements existing detection systems by diving deeper into both inappropriate payment detection and provider billing patterns and behaviors to accurately identify overpayments with a higher probability of recovery. By leveraging our engine and team of dedicated analysts and claims audit specialists, we deliver detection tools that go well beyond traditional system capabilities, generating millions of dollars in potential savings annually.
Our engine helps payer vendors automate and improve their data mining processes to more accurately identify anomalous provider billing patterns and coding errors. Utilizing unsupervised outlier detection modeling our engine deep dives providers on multiple features with higher dimensionality and benchmarks billing patterns compared to it’s peers. State Medicaid rules and regulations are also referenced through the engine to identify additional coding issues such as unbundling, upcoding and excess units. Through automation, vendors are realizing >35% improvement to detection systems.