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In order to achieve fi nancial sustainability for a health insurance operation, a comprehensive strategy of cost containment and fraud control must be in place. This involves the permanent monitoring of customer and provider´s behaviour, as well as the constant analysis of medical utilization data.
Our operational platform includes modules that can be integrated into our Clients’ systems to make the rules, processes and actions, part of their everyday operations. Our methodology follows the most sophisticated international guidelines and medical coding.
As well as the actions and rules that are triggered in real time, specific analyses are also performed periodically, using various mechanisms and data analysis to predict and identify possible cases of fraud or abuse.