Proactive Monitoring of High-Cost Claims Adjudication

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

For many organizations today, after the data load, their dashboard displays discrepancies without specific details. This not only takes more time to research but creates hidden costs for other AI technologies.

AI-based rapid root cause analysis

MCheck allows the end user to drill down to every data discrepancy, thus accelerating corrective measures. The tool identifies a targeted list of medical charts that should be reviewed and the target codes for nurses/coders to search for in the charts.

Finding the unknown

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

MCheck Solution

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Unique and accurate AI apporach

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

Easy data ingestion with insured security

We provide quick data ingestion with our Mcheck platform. Our technology is also compatible with most of the data source systems in the industry. HiLabs is HIPAA compliant and insured through virtual or cloud systems. In addition, our proof of concept does not require PHI information and generally takes 6-8 weeks.

Let’s Uncover Hidden Savings Opportunities

We at HiLabs are helping the largest payers in the country identify new and hidden savings opportunities that reduce data errors and operational costs. With decades of experience in the payer market, we are ready to bring about the change the healthcare industry so desperately needs.

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

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