SHIELD - Software for Health Insurance Eligibility Detection
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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.
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
Please click here for more information on Premium features or contact us.
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.
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.
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.
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
Please click here for more information on Premium features or contact us.
To learn more about subscribing to our service options, please contact us here
Overview
SHIELD is a system that automates claims medical adjudication, detects potential fraud, waste and abuse, and justifies denials. It combines rules-based and machine learning models to optimize insurers’ health claims outcomes.
Unlike other rules-based engines, SHIELD comes with standard rule sets for specific geographies, but also gives insurers the flexibility to modify rules or add their own. SHIELD not only detects potential fraud but can also approve or reject a claim, based on medical rules and machine learning models and automates decisions.
Medical claims are typically large volume and high frequency, which means they would need teams of experts to investigate them properly, resulting in higher costs and increased turnaround times. This is the area where SHIELD can add value by automating the medical adjudication of claims, shortening transaction times and achieving cost containment in insurers claims’ operations.
Key Features
- Medical rule engine,
- Outlier rule engine
- Supervised machine learning model
- Unsupervised machine learning model
- REST API
Key Benefits
SHIELD optimizes and automates medical claims processing and lets you respond more quickly to claimants and resolve legitimate claims faster, leading to greater customer satisfaction.
More specifically, SHIELD provides:
- Increased capacity to investigate and detect anomalies and inconsistencies
- Enhanced SLA compliance
- Improved turnaround times and customer experience
- Easy integration with existing processes and systems
- Lower claim costs