Shift Payment IntegrityShift Technology
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About
CoverSelf’s healthcare-specific, next-gen, cloud-native, and customizable claims accuracy platform is built from the ground up using modern software development techniques. It empowers users' long-term success by smoothly adapting to ever-evolving, dynamic claims, and payment inaccuracies, reducing complexities and administrative costs. This platform provides open access to all partners working to address claims inaccuracies, administrative waste & inefficiency, enabling them to build, customize, innovate & release at a faster pace. CoverSelf’s payment integrity platform engages modern technologies to address payment leakage & inaccuracies while remaining transparent & accessible to payers. Helps create new scenarios & data mining algorithms, innovating products, and expediting customization through this purpose-built platform, and increases speed to innovation. Claims are corrected and processed automatically, ensuring that there’s no additional human intervention or effort required.
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About
Shift’s Payment Integrity is an AI-powered solution for health plans designed to improve accuracy and reduce costs in the claims payment process. It works both pre-payment (before claims are paid) and post-payment, helping plan administrators catch issues early and recover overpayments. Key features include claims editing (with updated, dynamic rules), generative AI-assisted medical record review, anomaly & fraud/waste/abuse detection, and external data enrichment for deeper context. The system supports evolving policy and guideline changes, allowing automated policy analysis and edit logic workbench features so health plans can test concepts before deployment. It provides explainable flags/alerts (so reviewers understand why claims are flagged), tools to accelerate document review, highlighting relevant parts of records, data mining for emerging trends, and a unified case management UI for investigative workflows.
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Platforms Supported
Windows
Mac
Linux
Cloud
On-Premises
iPhone
iPad
Android
Chromebook
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Platforms Supported
Windows
Mac
Linux
Cloud
On-Premises
iPhone
iPad
Android
Chromebook
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Audience
Health organizations searching for a platform to manage, ideate, and execute their payment integrity programs
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Audience
Health plan administrators and healthcare organizations in need of a tool to reduce improper payments, detect emerging fraud and billing errors, and improve claims workflows
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Support
Phone Support
24/7 Live Support
Online
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Support
Phone Support
24/7 Live Support
Online
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API
Offers API
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API
Offers API
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Pricing
No information available.
Free Version
Free Trial
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Pricing
No information available.
Free Version
Free Trial
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Reviews/
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Reviews/
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Training
Documentation
Webinars
Live Online
In Person
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Training
Documentation
Webinars
Live Online
In Person
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Company InformationCoverSelf
United States
www.coverself.com
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Company InformationShift Technology
Founded: 2013
France
www.shift-technology.com/products/payment-integrity
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Integrations
No info available.
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Integrations
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