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Healthcare Fraud Detection Software Solutions

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Healthcare Fraud Detection Software Solutions

Fraudulent healthcare claims, waste, and abuse increase the burden of medical costs on everybody. OSP’ creates customized medical fraud detection software to address this issue by automating the healthcare fraud detection process. Our custom-build healthcare fraud detection software employs a comprehensive approach and consistent high-performing metrics dashboards to avoid low integrity medical billing errors and potential healthcare frauds in their nascent stages. Our medical fraud prevention software skilfully combines identity search technologies, predictive data analysis, fraud indicator compliance rules, the company claims information, and industry data sources to suspicious flag claim instantly. We can build fraud prevention software that is instrumental in detecting the probable fraudulent claims and safeguarding your business revenue.

THE GROWING CHALLENGES

The common bottlenecks which might slow down your business growth

real time analysis

Complex Audits and Asset Estimates

Tedious auditing procedures and asset estimates have been burdening healthcare organizations, causing a drain on the industry.

Non-responsive Solutions

Lack of Innovation

The financial and accounting dimensions in healthcare have been lacking innovation and are heavily paper-based with slow processes.

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Financial Prone Errors

The complexities of the healthcare financial system make it prone to errors that are sometimes difficult to identify by the human eye.

Regulatory Compliance

Increasing Frauds

With the inclusion of online transactions and multi-device accessibility, there is a higher vulnerability to frauds.

Higher Workforce Requirement

Lack of Personalization

With stringent systems in the traditional accounting models, customers are increasingly dissatisfied with services.

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Risk Factors

Due to the industry's nature, the risk factors are considerably high, and errors can have severe repercussions for the business.

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HOW OSP WORKS

Intensify Efficiency through OSP's Fraud Detection Software

Enrich the effectiveness of your revenue generation systems through our scalable healthcare fraud detection solutions.

Solutions

Predictive Data Analysis

Our fully-integrated and browser-based fraud software offer comprehensive functionality for predictive fraud detection in healthcare. At OSP, we create predictive data analysis that encompasses advanced analytics techniques, like statistics, text mining, data mining, and decision support engines. Our healthcare fraud software analyzes the complex and interrelated relationships among thousands of data sets to provide a potential fraud occurrence. We create medical fraud management systems that employ memory-based reasoning to identify similar cases from experience. It applies the collected information from these cases for in-depth classification and prediction. The memory-based reasoning applies to arbitrary data types, even non-relational data.

User Provisioning Protocols

OSP’ bespoke fraud management systems can provide user provisioning protocols – including role assignment, user management, and Single Sign-On (SSO) functions. The effective fraud detection software solution is made possible with user activity monitoring, access request management, and account management of multiple digital identities. Furthermore, we deploy automated fraud alerts to monitor patient data and receive emails when new information arises. Our tailored fraud management software allows access to proprietary detection technology, which identifies providers displaying anomalous patient billing trends and patterns through data mining technologies. OSP’s fraud management software is tailor-made to address the vulnerabilities within a particular healthcare organization, in tandem with specific users, providers, and patients in question.

Compliance Management

Remain compliant with state policies for healthcare payments to reduce investigation costs and avoid overpayments. Through electronic healthcare fraud detection technologies, we use automated systems that are free of errors, commonly made by human entries. This is because the technology used is consistent in its data entry features and in its analysis of the very same data to ensure holistic compliance. This feature is a must-have and eliminates the requirement for manual intervention of data reentries. The healthcare fraud detection system is geared to generate the data based on initial entries automatically. Thus, the data is organically created and generated and programmed efficiently. The software can be created with the provision of regular updates to keep up with evolving compliance requirements.

Link and Component Analysis

OSP’ healthcare fraud detection solutions can be made to find the concealed relationship among multiple payment data parameters, which may not be otherwise apparent. Further, our systems minimize the complexity of visual variance analysis by reducing the multi-dimensional data sets to 2 -3 dimensions. We build healthcare fraud detection solutions to create satisfaction among all healthcare industry entities through a diminished financial burden. Through our customized approach, we adhere to the organization’s specific requirements and build software that is easy to use, rich in features, and user-friendly in its approach through multiple functionality levels. Our software can be well integrated into the EHR system of the healthcare agency or practice.

Optical Character Recognition (OCR)

OSP’s fraud detection software solutions can streamline the process through the entire lifecycle of claims submission. Whether it is a convenience of electronic data entry or validation through the use of technology or even the flexibility of errors being flagged before submission – the benefits are endless of a carefully crafted system that is evident in increasing revenue. Through intelligent technologies within the fraud detection software solutions, we offer the Optical Character Recognition (OCR), which has a high potential in diminishing the possibility of serious errors in coding and claims filing. This is done through the efficient scanning of documents and electronic programming and isolation.

Highlighted Discrepancies

Our solutions are created with the capacity to highlight claims that are likely to be rejected or refused. This will enable faster problem-solving and efficiency, thereby increased. Based on past inputs, our fraud detection software can predict claims that are potentially those which could be denied. Prioritization becomes much easier through this feature, with attention demanded towards areas of immediate attention, such as pending matters. Accessibility is further increased through electronic documentation and records and real-time access to current and past records, along with areas that need to be checked. It also reduces the need for manual processing. Finally, professional claims can be adjudicated in real-time through interactive, transactional experiences.

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USE CASES

What We Offer?

custom healthcare software development | custom healthcare solutions

Reduced Liabilities

OSP's fraud detection software solutions help determine the fraudulent claims and provide an immediate warning of waste and abuse to reduce fraudulent liabilities. Our technology's proactive abilities reduce claim errors by identifying fraud, waste, and abuse patterns & trends in healthcare. Our solutions ensure the maintenance of the highest level of claim compliance for prompt reporting and appropriately responding to fraudulent activities. We further ensure professional experts' assistance to build highly customized fraud, waste, and abuse management solutions. Our solutions are designed to provide real-time access to falsified and wasteful information by including robust analytical models into the process workflow. Our systems execute the identification of repeat offenders and uncovering collusive frauds by applying risk-based scoring models.

Healthcare specialty billing software solutions

Comprehensive Features

We build solutions that allow a consolidated view of emerging threats to formulate robust preventive mechanisms for frauds, waste, and abuses. Our fraud detection software enhances benefit accuracy and fiduciary responsibility to proactively create cases for further investigation, collection, and prosecution. Through customized deployment, identifying fraudulent activities upfront can go a long way in avoiding the expenses required for investigative and legal actions. Our software applies analytics toward the benefit of the entire revenue cycle management, with a specific goal was to optimize and reduce frauds and increase overall revenue. Our goal is to provide prompt access to critical financial metrics and a tool to assist with quick problem solving through a data-driven approach. We create a streamlined data coalition system for informed and accurate decision-making on data analytics toward revenue cycle management.

Outcome-based Analytics

Data Mining

At OSP, we undertake the process of analyzing large chunks of data to discover meaningful patterns and trends through complicated mathematical calculations that offer predictable outcomes toward fraud detection. The process creates a possibility to answer complicated questions that remain beyond bounds of simpler analysis techniques. Through an automated revelation of patterning, we create customized models that use algorithms to determine a certain set of data. These models create discoveries by analyzing the large chunks of data that extend into fraud predictions. By grouping the data into meaningful sections, data mining can offer a summarized view of information that can be actionable and reduces the overall rate of fraud. Through the automated nature of our data mining models, the dependence on manual entries is significantly reduced, and much larger amounts of data can be used.

Keeping Your Trust, Always

We follow every government's regulatory mandate and create solutions that adhere to strict protocols.

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