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Chargemaster Analytics: Detect Increase in Billing Amount

Client

Large healthcare insurance provider based in Indiana

Business Problem

In healthcare insurance, a chargemaster is a comprehensive list of items billable to an insurance provider, usually containing highly inflated prices which is difficult to verify

Objective

Quantify and verify quarterly increases in payments to providers

Abzooba’s Solution:

  • The solution uses advanced statistical and machine learning algorithms – both in the discrete and continuous domains – to detect billing amount increases with high confidence
  • Claims data is analysed and the increase in quarter-over-quarter billing for different revenue and CPT codes are calculated
  • For cost increases outside permissible limits, high confidence intervals have been constructed to support the results
  • The final outcomes from the negotiations are incorporated as a feedback loop into the algorithms to improve accuracy

Business Benefits:

  • Detects an increase in billing amount
  • Facilitates payer-provider contract negotiations
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