Centaur for Payers
Artificial Intelligence detecting and preventing medical 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 medicare billing fraud systems.
The Payment Integrity Centaur
The Centaur’s AI-based platform is designed for healthcare payers to automatically and economically find past, present and emerging medical 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.
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 medical 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