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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
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