2.2% of claimants generate 23% of total reimbursements
Mitigate high-cost claim overpayments and predict future liabilities by turning raw claims data into actionable strategic intelligence. Focused solely on the most expensive and complex claims, our AI-driven platform forensically identifies, financially analyzes, methodically predicts and clinically evaluates treatment appropriateness. The results allow payers and risk entities to effectively manage their plan and project risk. After all... Knowledge Is Power.
We built The Predict Platform specifically to analyze, identify and report on the 5% of members driving 50% of total medical spend. Our innovative platform is a data driven analytics powerhouse able to pinpoint the drivers of high-cost claims that PBMs and cost-containment companies are ill-equipped to find.
We weren't impressed with the status quo of one-dimensional health plan analytics ... so we did something about it.
We built an innovative healthcare IT platform powered by thousands of in-depth clinical review algorithms and advanced financial analytics to deliver the next generation of insight into high-cost claims. The Predict Platform quickly analyzes data to seek out specialty drug claims, inflated medical implant charges, and clinically inappropriate treatments and dosing regimens.
With dynamic reporting capabilities, continuous database updates, clinical insight and projections for high-cost members, The Predict Platform provides the strategic intelligence required to confidently guide business initiatives.
The Predict Platform is undeniably the most comprehensive and versatile resource for intelligent data analytics available today.
Our cloud-based platform that enhances risk mitigation efforts with three modules focusing on a specific cost-driver; Complex Diagnoses, Specialty Drugs and Medical Implants.Learn More
FACS is a financial and clinical surveillance engine that leverages the Predict Suite to automatically examine claims, flagging those that warrant additional review.Learn More
Profiler leverages Predict Suite analytics to identify, report on, and project future costs of members with catastrophic diagnoses.Learn More
Housed on the Predict Platform, the Predict Suite includes three continuously updated data modules, each focusing on the three main cost-drivers. Each includes clinical insights and financial analytics that encompasses data representing the entire payer marketplace.