Naviquis Navigator Newsletter - October 2024
The latest trends for AI in Healthcare and the importance of Fraud, Waste, and Abuse detection for TPAs.
top of page
OUR COMPANY
Naviquis: Navigating Payment Integrity
Revolutionizing Healthcare Payments with Innovative Solutions
Our company is committed to driving transformative change in the industry by delivering innovative technologies that optimize payment integrity processes, combat fraud, and enhance provider communications.
Naviquis is poised to revolutionize healthcare payment integrity and contribute to improved financial health and better provider outcomes.
WHO WE ARE
Leaders in Payment Integrity Solutions
Naviquis utilizes a combination of algorithms, expert systems, artificial intelligence (AI), machine learning (ML), and Mobilized Computable Biomedical Knowledge (MCBK) to provide a near real-time healthcare fraud, waste, and abuse (FWA) automated detection and prevention solution. Our secure solution helps identify suspicious and/or inappropriately coded claims before they are paid providing an immediate ROI.
Our talented team, consisting of experienced professionals with backgrounds in AI, software development, clinical care, healthcare policy, forensics, and biomedical informatics, has developed a payment integrity solution.
Our end-to-end solution detects and prevents fraudulent activities in real-time to reduce overall costs for medical and/or dental claims.
OUR PRIMARY SOLUTIONS
Naviquis Payment Integrity Solution:
This one-of-a-kind FWA management solution enables healthcare payers to finally make a huge impact on fraud, waste, and abuse (FWA) by moving from a “pay and chase” and “manual review” model to an automated “detect and prevent” model.
The solution includes real-time FWA detection systems for medical and/or dental claims, and a Provider Relationship Management (PRM) Platform for communication between your health plan and your providers.
Medical and Dental Claims:
The Naviquis solution identifies potential FWA before a medical and/or dental claim is paid, while analyzing data needed to prevent FWA. This increases your overall efficiency, lowers costs, and results in satisfied clients and members.
Provider Relationship Management Platform (PRM):
The PRM provides full transparency to the providers and reduces abrasion and administrative costs. This fully automated, real-time communications and tracking system capitalizes on cognitive bias of provider’s judgement when deviating from what would be considered desirable accepted norms.
RELATED ARTICLES
Fully Automated with No False Positives
Catch Small, Catch Early, Catch All - Save Significantly!
bottom of page