ClaimShark

ClaimShark tracks the entire lifecycle of a claim starting from the time the claim file is sent to the vendor (internal audit team and external vendors), to when a claim is tagged for savings - as it goes through the validation process, and later through the collections eort, receipt of funds, and appeals. While tracking the lifecycle, it provides robust reporting on all the activities of the audit teams, including concepts leading to savings, vendors tagging the claims, and the recovery. It provides real-time information on savings and helps with managing payment integrity departments. ClaimShark is built on a hub and spoke model. The hub is the Health Plan and the spokes are the internal audit teams and external vendors that are contracted to identify over payments. These teams and vendors can be engaged based on dierent criteria, such as line of business, lag, recovery type (concepts), geographic allocation, dollar value, and claim. Add and layer different vendors by concept, lag, LoB etc. Gain valuable insights into Payment Integrity operations and leakage. Assign the right audits to Vendors based on their strengths as demonstrated through historical data and insights. Optimize backend operation leveraging automation and machine learning. Increase savings through insights and data. ClaimShark tracks the entire lifecycle of a claim within the payment integrity process starting from the time the claim file is sent to the vendor (internal audit team and external vendors), to when a claim is tagged for savings - as it goes through the validation process and later through the collections effort, receipt of funds, and appeals. While tracking the lifecycle, it provides robust reporting on all the activities of the audit teams, including concepts leading to savings, vendors tagging the claims, and the recovery. It provides real-time information on savings and helps with managing the payment integrity department. Some of the features and functionality of the Claim and Inventory Management module include: Documents ...