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Centaur for Payers

Artificial Intelligence detecting and preventing fraud, waste and abuse

Sharecare Payment Integrity works across the entire healthcare payment continuum from patient to provider to payer, bringing a heavy dose of AI, data science and innovation to combat healthcare fraud, waste and abuse (FWA).

Pre-payment, post-payment, and special investigation units

To ensure maximum savings while improving the overall health and well-being of their members, health plans need a constantly evolving suite of payment integrity solutions. Artificial intelligence and advanced analytics solutions can help payers uncover substantial savings opportunities they miss using traditional rules-based payment integrity systems.
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The Payment Integrity Centaur

The Centaur’s AI-based platform is designed for healthcare payers to automatically and economically find past, present and emerging healthcare claims fraud, waste and abuse issues. Our all-inclusive platform utilizes patent-pending AI-based technology to uncover new insights and schemes not possible with traditional investigative processes and procedures, empowering payment integrity units with a powerful, easy-to-use tool.
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Payer markets we serve

Commercial health plans, government health plans, third-party administrators, and self-insured

  • Outperforms rules-based systems
  • Improved error detection
  • Consistent high-performance metrics regardless of time on task
  • No bad habits and/or easy to re-train
  • Independently adjusting AI
  • Uses AI to understand and present fraud, waste and abuse patterns and trends
  • Client-owned /pre-existing tools easily integrated into the Centaur
  • Applies clinical code edits with specific and unique business rules to reflect and enforce a payer’s contracts and payment policies
  • Reduces false positives
  • Maximizes investigatory workflow by prioritizing outcomes by only bringing the most complicated files and issues to the attention of investigators and analysts
  • Can be positioned at any position in the claims process for maximum impact
  • Increases auditing volume
  • Reduces work shortages
  • Lowers the cost of claims processing
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