HEALTHCARE PAYMENT INTEGRITY SOLUTION
Detection | Prevention | Transparency | Communication
WHERE INNOVATION MEETS CREATIVITY
Combining the Power of AI + ML + MCBK
Naviquis utilizes a combination of algorithms, expert systems, computable biomedical knowledge, artificial intelligence (AI), and machine learning (ML) to offer an almost real-time solution for automated detection and prevention of healthcare fraud, waste, and abuse (FWA).
Our secure solution identifies suspicious claims before payment, providing communication, alerts, credentialing support, and educational notes to providers through the Naviquis Provider Relationship Management System (PRMS). This proactive strategy not only enhances payment integrity but significantly increases client savings and reduces provider abrasion and administrative costs.
Designed to Reduce Abrasion & Improve Relations With Your Network
The PRMS encompasses a suite of advanced functionalities, including:
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Communication Platform:
Ensures secure, fully automated, real-time communication with providers, streamlining the exchange of crucial information.
Provider Engagement:
Minimizes the risk of provider abrasion, optimizing the efficiency of FWA programs by maintaining transparent and effective communication channels.
Education Hub:
Delivers a wealth of educational materials to providers, fostering awareness of fraud, waste, and abuse prevention strategies. This initiative promotes a culture of compliance and shared responsibility within the healthcare network.
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Monitoring Support:
Offers assistance for credentialing and licensing through proactive monitoring, identifying and addressing potential issues before they escalate.
AVOID IMPROPER PAYMENTS
with Our Insurance Fraud Detection Software:
A Real-Time, Fully Automatic, Post Adjudication, Pre-Pay Payment Integrity Solution
Business Intelligence
Precision Edits
Reporting Analysis
Communication
Identify Suspicious Claims BEFORE They Impact Your Bottom Line
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Fight back with our innovative Insurance Fraud Detection Software!
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Our post-adjudication, pre-pay integrity solution detects and prevents most common errors and fraudulent activities. This comprehensive solution reduces overall costs and provides an immediate ROI while increasing client savings, TPA revenues, and provider satisfaction.
2012
Year
Established
5%
Average Savings Found by Naviquis
10 to 1
ROI
Utilizing Naviquis