
Software for Health Insurance Eligibility Detection - SHIELD
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Subject to reasonable use.
Survey Summary
The Survey Summary provides a download of the vendor profile, solution profile and the VendorMatch Discovery survey vendor responses used to power the directory. All responses are provided by the vendor online.
Note that this report is a high level summary of the vendor's credentials and a solution's capabilities designed to assist with solution short-listing. The RFX report is the more comprehensive Request For Information report designed to support evaluation and selection, this will only show where the vendor has completed the "RFX" RFI.
HOW TO SUBSCRIBE
To protect vendor data only financial institutions and recognized advisors can subscribe to VendorMatch Premium. Please click here for more information on Premium features or contact us to discuss a subscription.
RFX Report
The RFX report is an XLS download of the Vendors response to the “RFX” Request for Information for this solution.
The RFX is a centralized golden copy of a RFI authored by our analysts based on their expertise in running real-life system evaluation and selection projects and completed by the vendor online.
Note to protect vendor that only Financial Institutions and recognized Advisor can subscribe to this feature.
In each instance the first time the link is used the user requests permission to access the RFX report and it is the vendor who is required to authorizes access. You will be alerted when the vendor has reviewed your request and granted permission.
HOW TO SUBSCRIBE
You can activate this feature with a VendorMatch Premium subscription. Please click here for more information on Premium features or contact us to discuss a subscription.
To learn more about subscribing to our service options, please contact us here
This feature is upgradeable
For End Users
You can activate this feature and other links for ALL VENDORS with a VendorMatch Premium subscription. Additionally you can gain access to an increased depth of data, summary reports, RFX reports (detailed completed RFIs - available to financial institutions only) and comparison grids. Please click here for more information on Premium features.
For Vendors
Vendors can activate their links and gain access to analytics by upgrading to VendorMatch PRO. Please click here for more information
Speak with an analyst
Financial institutions and their advisors can subscribe to our Analyst Access* service. Effectively phone or (email) a friend you can have on tap advice and support provided by our analysts on this vendor, solution or solution category.
HOW TO SUBSCRIBE
To protect vendor data only financial institutions and recognized advisors can subscribe to VendorMatch Premium. Please click here for more information on Premium features
or contact us to discuss a subscription.
Subject to reasonable use.
Survey Summary
The Survey Summary provides a download of the vendor profile, solution profile and the VendorMatch Discovery survey vendor responses used to power the directory. All responses are provided by the vendor online.
Note that this report is a high level summary of the vendor's credentials and a solution's capabilities designed to assist with solution short-listing. The RFX report is the more comprehensive Request For Information report designed to support evaluation and selection, this will only show where the vendor has completed the "RFX" RFI.
HOW TO SUBSCRIBE
To protect vendor data only financial institutions and recognized advisors can subscribe to VendorMatch Premium. Please click here for more information on Premium features or contact us to discuss a subscription.
RFX Report
The RFX report is an XLS download of the Vendors response to the “RFX” Request for Information for this solution.
The RFX is a centralized golden copy of a RFI authored by our analysts based on their expertise in running real-life system evaluation and selection projects and completed by the vendor online.
Note to protect vendor that only Financial Institutions and recognized Advisor can subscribe to this feature.
In each instance the first time the link is used the user requests permission to access the RFX report and it is the vendor who is required to authorizes access. You will be alerted when the vendor has reviewed your request and granted permission.
HOW TO SUBSCRIBE
You can activate this feature with a VendorMatch Premium subscription. Please click here for more information on Premium features or contact us to discuss a subscription.
To learn more about subscribing to our service options, please contact us here
This feature is upgradeable
For End Users
You can activate this feature and other links for ALL VENDORS with a VendorMatch Premium subscription. Additionally you can gain access to an increased depth of data, summary reports, RFX reports (detailed completed RFIs - available to financial institutions only) and comparison grids. Please click here for more information on Premium features.
For Vendors
Vendors can activate their links and gain access to analytics by upgrading to VendorMatch PRO. Please click here for more information
Speak with an analyst
Financial institutions and their advisors can subscribe to our Analyst Access* service. Effectively phone or (email) a friend you can have on tap advice and support provided by our analysts on this vendor, solution or solution category.
HOW TO SUBSCRIBE
To protect vendor data only financial institutions and recognized advisors can subscribe to VendorMatch Premium. Please click here for more information on Premium features
or contact us to discuss a subscription.
Subject to reasonable use.
Survey Summary
The Survey Summary provides a download of the vendor profile, solution profile and the VendorMatch Discovery survey vendor responses used to power the directory. All responses are provided by the vendor online.
Note that this report is a high level summary of the vendor's credentials and a solution's capabilities designed to assist with solution short-listing. The RFX report is the more comprehensive Request For Information report designed to support evaluation and selection, this will only show where the vendor has completed the "RFX" RFI.
HOW TO SUBSCRIBE
To protect vendor data only financial institutions and recognized advisors can subscribe to VendorMatch Premium. Please click here for more information on Premium features or contact us to discuss a subscription.
RFX Report
The RFX report is an XLS download of the Vendors response to the “RFX” Request for Information for this solution.
The RFX is a centralized golden copy of a RFI authored by our analysts based on their expertise in running real-life system evaluation and selection projects and completed by the vendor online.
Note to protect vendor that only Financial Institutions and recognized Advisor can subscribe to this feature.
In each instance the first time the link is used the user requests permission to access the RFX report and it is the vendor who is required to authorizes access. You will be alerted when the vendor has reviewed your request and granted permission.
HOW TO SUBSCRIBE
You can activate this feature with a VendorMatch Premium subscription. Please click here for more information on Premium features or contact us to discuss a subscription.
To learn more about subscribing to our service options, please contact us here
Overview
A SHIELD for medical claims automation and fraud, waste, and abuse detection
While underwriting automation is widely implemented, medical claims are yet to be fully automated, despite their large volumes, high frequency, and overall average cost. igital transformation empowers customers to expect instantaneous responses from insurance companies; thus, medical claims automation becomes imperative for their competitiveness.
According to Deloitte1, insurance organizations are under constant pressure to offer improved services at reduced costs, specifically for claims management. However, still, millions of invoices are checked manually to weed out all the unjustified claims. This process is a lengthy, paper-heavy one that requires time, expertise and costs a lot of money. In addition, manual checking does not always discover all the errors in invoices, and decisions can be false.
Real-time Automatic Claim Management
To minimize the risks of such a manual process, MR HealthTech created the Software for Health Insurance Eligibility Detection (SHIELD), a high-performance claims management engine for increased automation and fraud, waste, and abuse detection to health insurers. SHIELD checks automatically the medical plausibility of invoice items and instantly identifies incorrect invoices.
Key Features
Medical Plausibility
SHIELD is a configurable system that easily integrates into the health insurer's existing IT landscape and workflow. During the Authorization and Claims processing, created through either manual insert or automatic import, SHIELD evaluates each Invoice Line against the system’s full spectrum of rules.
It then determines whether an invoice is reasonable and appropriate from a medical viewpoint, and provide a result for each rule, informing the user about each decision’s reason.
Powerful Cost Containment
Along with the medical rule types, SHIELD also incorporates historical rule types to recognize contradictions from already settled claims data and cross-check the current medical circumstances. For example, if a Once-in-a-Lifetime (OLT) procedure was performed on a patient at an earlier date, the same OLT procedure billed now is automatically rejected by the system.
Also, Outlier Detection rule types in the system provide cost containment. For example, if a surgical procedure has a minimum value of 1,000$ and a maximum value of 3,000$, any benefit submission outside this price range will trigger the rule.
It works either stand-alone or integrated with any insurance back-office system enabling even legacy technologies and operations to become more agile and efficient.
Key Benefits
SHIELD will allow you to:
- Reduce the turn-around time
- Increase client satisfaction
- Reduce the risk of fraud, waste and abuse cases
- Increase the automatic adjudication of claims reducing the cost
- Provide transparency and consistency in the claims' adjudication
Higher clear-up rate within a shorter period
Multiple pilots and PoCs over the past two years have shown that SHIELD increases the claim processing automation between 20% and 30%. This result translates into faster and more straightforward claims assessment and processing. Working more effectively with SHIELD, the claims assessors spend less time reviewing large numbers of claims and instead focus on investigating inconsistent claims.
Learn more about how SHIELD can automate your claims process by sending us an email at sales@mrhealthtech.com
1Deloitte – The future of insurance claims management article (https://www2.deloitte.com/global/en/pages/financial-services/articles/insurer-of-future-claims.html)