Our Products

MCheck™ Payment Accuracy

MCheck™ Payment Accuracy Reduces Claims Overpayments due to Operational Errors, Saving Plans Millions

Overview

MCheck™ Payment Accuracy lowers costs for health plans by identifying claims overpayments stemming from operational errors. This intuitive platform helps achieve very high payment accuracy utilizing state-of-the-art machine learning and deep learning algorithms. It is compatible with large datasets, highly customizable, and can be deployed in both on-premise and cloud environments rapidly.

Our team works closely with various industry experts, providers, health plans, and other stakeholders to ensure that our product is continuously updated with the new advancements in claim processing systems. Trained on large claims datasets, our AI models quickly became exceedingly efficient and accurate in flagging overpaid claims. They can be easily integrated into the pre-payment claim auditing systems, thereby avoiding the operational hassles of post-payment auditing systems.

Approach
Features
Compatible with all big data storage systems

The platform is compatible with Hadoop File System, Snowflake, AWS S3, delimited files and many more storage systems.

Automated Data Quality Checks

This tool has capability to identify common errors in the claims data.

High Accuracy AI Model

MCheck™ Payment Accuracy runs on continuously improving artificial intelligence algorithms with >95% accuracy.

Pre-Pay Integration

Ready to ship APIs can be integrated with pre-payment auditing systems for proactive flagging of overpaid claims.

Dashboards with Actionable Insights

Explainable AI provides real-time insights on reported claims.

our process03
Value for Customers
Enormous Cost Savings

Claims reimbursements are the primary cost for a health plan and those costs combined with the cost of recovering incorrect payments has become a huge problem for health plans. Recovering the extra amount that has been paid to the provider can be quite cumbersome. MCheck™ prepayment API that helps health plans to detect overpayments before the amount is paid to the provider. With our highly accurate models, health plans can save a lot of money by integrating our product into their claim auditing systems.

Improved data systems

Our platform enables root cause analysis that not only identifies anomalous claims, but also provides the evidence for why the claim was overpaid and how it can be adjusted to recover the overpayment. Through this process, it discovers key operational and systemic errors in data systems that can be quickly addressed before they affect broader downstream and upstream systems.

Reduced Member & Provider Abrasion

With more accurate claims payment, health plans can minimize negative experiences with members and providers due to incorrectly processed payments and focus on delivering better services to their members.

Why MCheck™ Payment

MCheck™ Payment Accuracy proactively detects claims overpayments using a novel, machine learning enabled approach. This captures errors that cannot be recognized using traditional, deterministic approaches.

Our team includes experienced professionals with multi-faceted skillsets: Physicians practicing at renowned hospitals, Data Scientists adept at both building machine learning models validation in real-world claims processing systems, Technology Experts who ensure our platforms are scalable and adaptive to serve the needs of a variety of customers, and Healthcare Consultants and Operations Experts who provide subject matter expertise and work with customers. This unique combination enables us to truly tackle problems from multiple perspectives and design robust solutions.

We saved over $1M for a large health plan in the United States just by analyzing claims data of one state from one year with over 95% accuracy, leveraging our product for retrospective claims analysis.

MCheck™ Payment driving healthcare innovation and data transformation

Request more information