4L Data Intelligence

Website: https://4ldata.com/

4L Data Intelligence™ uses the patented power of Integr8 AI™ to find, fight and prevent fraud, waste, and abuse fast with the revolutionary provider-centric FWA approach. Integr8 AI technology, coupled with our continuously credentialed provider database, detects FWA you can’t see with claim data-centric approaches, solving a challenge every payment integrity platform has today.

The 4L FWA Prevention™ solution rapidly detects and prevents FWA at five points across the claims management workflow including pre pre-payment, pre-payment and post-payment positions. At each point, Integr8 AI dynamically and continuously detects provider behaviors, relationships, and outlier status without the limitations of rules-based and claim data-centric solutions. In short, it enables you to see what providers are doing individually, in relationship with all other providers, and in relationship to all other claims on each-and-every claim submitted.

4L FWA Prevention pre-payment and post-payment detection and prevention results are delivered in four distinct categories. These are:

• Provider Integrity Edits
• Adaptive Claims Edits
• Provider Behavior Analysis
• Provider Schemes Analysis.

For fraud and SIU teams, Integr8 AI detects fraud and collusion schemes you can’t see now, or can’t see fast enough, with claim-centric approaches. Our suite of tools automates continuous near real-time SIU-in-a-box detection and documentation so you can Find, Fight and Prevent Fraud Fast™.

AMS Intelligent Analytics

Website: http://www.amspredict.com/

 Advanced Medical Strategies (AMS) is the premier provider of payment integrity, risk management, and business intelligence solutions to identify and address excessive claims, prevent and recoup overpayments, and effectively manage the risks associated with high-cost claimants and group health underwriting.