Proactive DQM in claims processing system

How do we solve this problem?

MCheck, an artificial intelligence-based platform automates the analysis of health data errors at scale. The platform’s algorithms run on a powerful, statistical, multi-model and self-learning engine to identify data errors, with minimal manual input. The algorithms are customized to analyze healthcare data, and is scalable. To put AI into action, all results generated by the algorithms are supported by auditable “facts” and not based solely on a probabilistic model.

Proactive approach compared to the traditional reactive fire fighting

Today after the load, the dashboard shows discrepancies in the data counts without any drilled-down details. This not only takes up more time but adds up hidden costs

AI-based rapid root cause analysis

MCheck allows drill down of every data discrepancies hence accelerating corrective measure. The tool identifies a targeted list of medical charts that should be reviewed, target codes for nurses/coders and automated solutions to search for in these charts

Finding the unknown

The few proactive data quality management solutions that do exist are generally rules-based. They can handle only those types of data quality errors that organizations are already aware of. It cannot find new or unknown scenarios of data errors

MCheck Solution

payer-solutions_0014_vector-smart-object

Unique and accurate AI apporach

The tool identifies potential members with the highest probability of inaccurate/incomplete coding. In addition, it generates, with at least 90% confidence, a list of missing/inaccurate codes for each potential member.

Easy data ingestion with insured security

Quick data ingestion on our MGest platform which is compatible with most of the data source systems in the industry. Data security insured through virtual or cloud systems

Let’s make an impact

We at HiLabs are making businesses better for several of the country’s health plan. We understand your needs, are flexible to customization and are ready to bring in the change through our rich experience in this industry

payer-solutions_0014_vector-smart-object

About HiLabs, A cohort of experienced Engineers, Data Scientists and Physicians.

Subscribe to our newsletter and stay up to date with the latest news and deals!