Case Study: Healthcare

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