Health plans are witnessing tremendous increase in volumes and complexity of claims stemming from ageing population, complex coverages, shift to value-based contracting and continuously evolving regulations. In this environment traditional approach of sample-based techniques are challenged to scale and deliver value.
Exponential AI’s Decision Agent driven Audit solution helps scale claims audit processes to cover of 100% claims volume. The audit solution recommends real time audit decisions across all incoming claims.
Audit that works for you
Decision Agent based AI solution
- The audit center provides an intuitive interface for auditors to mange their workload, recommendations, across the claims lifecycle.
- The Agent based recommendations are provided for administrative, clinical and contract audit to categorize and flag claims by error types using historical patterns.
- The audit center allows investigators to provide feedback to system to continuously learn and improve recommendation.
- The Audit solutions comes with a dashboard to monitor Key KPI across the audit lifecycle.
- Insights are provided right from intake, tracking up to resolutions. The dashboard provides financial, operational and decision insights to enable easy management across the cross section of process.
- The reporting dashboard is easily configurable and customizable for your unique process needs.
- The operation centre delivers capabilities to manage the audit life cycle process. It allows managers, supervisors, process owners to collaborate and mange work across investigators and operators.
- The centre provides intelligent routing and prioritization based on financial inconsistencies and potential anomalies.
Drive Measurable Business Impact
Maximizes overpayment recovery, reduces improper payment waste,
and promotes provider satisfaction
Reduction in lead time
Optimizes investigatory workflow by bringing only the most complex files and issues to the attention of investigators and analysts
Decrease in Audit Costs
Provides experienced, highly trained decision agents to make most decision and auditors to focus on exceptions.
Reduction in FWA
Uses AI to enable discovery of fraud, waste and abuse patterns and trends. Continuously improve capabilities with feedback.
100% Audit Impact in week not months
Ready to GO
Audit is out of the box solution that comes with a smart start mechanism to immediacy start delivering value. Doesn’t require any integration with you existing systems.
Built for your process
Audit works with your existing investments and can easily be customized for your requirements. You an configured and train our decision agents to follow your policies.
Scale to 100% Oversight
Go from sample based audit to 100% in weeks. Enable investigators to focus on error claims, no more wasting time on clean claims.
Transparency, Control, Ownership
Experience touchless audit customized for your process. Drive transparent, explainable and trusted audit recommendations.