Mid-Case Consultation

AI/ML Claim Validation

Claim validation with 98.5% accuracy on cloud-architecture that can live review 100s of thousands of claims/hour, indefinitely.

Data Review Session

ClaimScore data experts will walk you through the results so you can understand ClaimScore's capabilities to the fullest extent.

Insight Reports

Insight Reports provide aggregated claim results, a timeline of claim submissions, and spike analyses when submission rates peak.

What you'll learn from a Mid-Case Consultation.

Claim fraud is complex and there are many questions that may arise as you look for a viable solution to the problem. We are here to answer those questions.

What percentage of the claims are actually eligible for payment?

Once the claims are run through ClaimScore, each will be marked as approved or rejected. Insight reports will indicate aggregated results so you will know the percentage of each.

How can real claims be distinguished from fraudulent ones?

Let our experts walk you through the results; the combination of ClaimScore's score & deduction codes unveil complex fraud patterns that are otherwise needles in haystacks.

How will we know which claims to actually pay?

Unfortunately, the mid-case consultation is limited to aggregated results. But upgrading to a retro-review is effortless and provides individual results for each individual claim.

How can we educate the court and stakeholders?

If you choose to upgrade to a retro-review, ClaimScore's results include a full set of deduction codes for each claim; plus we can provide a declaration if requested.

Real Time Validation

ClaimScore connected directly to Admin's claim form and results sent directly to Admin's claim management system, in real time.

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Retroactive Claim Review

Bulk review claims during or after the claims period. Securely send claim files to ClaimScore and ClaimScore securely returns result files.

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