Reducing fraud, waste & abuse in healthcare claims pre-or-post-payment with comprehensive analytics.
CGI ProperPay is a medical claim analytics solution enabling healthcare payers to easily and securely identify, predict and prevent improper payments of inpatient, outpatient and professional claims.
Advanced algorithms are used to identify hidden patterns and anomalies within a payer’s entire claims universe to indicate which incoming claims should be suspended or rejected from payment to a provider, and which paid claims have high potential for recovery.
CGI ProperPay analyzes claims using industry standard, CGI proprietary, and client configured edits to generate information such as:
- An export file of the claims with identified issues and resulting actions to suspend or reject payment of claims in process, or to audit, investigate and recover claims already paid.
- A dashboard providing valuable insights for focusing on the most productive claims for recovery. Graphical views and comprehensive reports help payers identify patterns such as doctor shopping and excessive provider services in the business day. Other examples include 3D visualization to highlight abnormal behavior between providers and laboratories.
CGI ProperPay does the heavy lifting so payers can realize these benefits without affecting business users, and free up valuable IT resources for other priorities.