Alivia Analytics provides AI-driven payment integrity solutions that enhance pre- and post-payment processes for healthcare claims, focusing on fraud detection and recovery. Their technology improves operational efficiency and reduces medical expenses for healthcare payers by identifying missed recoveries and automating corrections.
Funding
Funding not disclosed
CCHEFounders
Product
Problem
Healthcare payers face challenges in accurately processing claims, leading to financial losses through fraud, waste, and abuse (FWA). Traditional methods often miss complex schemes and emerging threats, resulting in overpayments and compliance issues.
Solution
Alivia Analytics provides AI-powered solutions to enhance payment integrity for healthcare payers, addressing both pre- and post-payment processes. Their platform leverages advanced analytics and machine learning to identify discrepancies, coding errors, and anomalous billing patterns indicative of FWA. By integrating with existing claims systems, Alivia automates the detection of improper payments, facilitates efficient case management, and supports compliance with healthcare regulations. The company offers a suite of tools, including FWA Finder™, Alivia Case Manager™, and clinical review services, to provide a comprehensive approach to payment integrity.
Target Audience
Alivia Analytics serves government and commercial health plans, including Medicaid, Medicare, Medicare Advantage, State Employee Benefit Plans, Private Health Insurance Plans, Employer-Sponsored Insurance (ESI), Third-Party Administrators (TPAs), and Self-Insured Employers.
Features
- AI-driven analytics for automated claims review and interrogation
- FWA Finder™ to accelerate fraud investigations with actionable insights
- Alivia Case Manager™ for streamlined management of fraud cases and compliant reporting
- Clinical review services led by expert clinical and coding auditors
- Data mining capabilities to identify inappropriate payments and anomalous provider billing patterns
- Claims editing to identify coding errors and ensure compliance before claims are processed
- Integration with existing claims adjudication and payment workflows
- Real-time statistics and configurable dashboards for enhanced visibility