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