Shift Payment Integrity

Shift Payment Integrity

Shift Technology
WizRule

WizRule

WizSoft
+
+

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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.

About

WizRule, data auditing, automatically reveals patterns in the data under analysis and points at cases deviating from these patterns as suspected errors or frauds. A suspected fraud or error is defined as a case that deviates from valid patterns. WizRule is used by auditors, fraud examiners, forensic investigators, data-quality managers. One of their main tasks is revealing fraudulent cases and errors in data. WizRule can help in carrying out this task. WizRule is a data-auditing tool based on data mining technology. It performs an analysis of the data revealing inconsistencies and "strange" cases to be investigated. WizRule works automatically – the user just selects the data and WizRule does the analysis. WizRule checks all the relationships among the values within the various fields and reports unexpected and unlikely cases. WizRule reveals fraudulent cases missed by the standard auditing tools.

Platforms Supported

Windows
Mac
Linux
Cloud
On-Premises
iPhone
iPad
Android
Chromebook

Platforms Supported

Windows
Mac
Linux
Cloud
On-Premises
iPhone
iPad
Android
Chromebook

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

Audience

Auditors, risk managers, fraud examiners, forensic investigators, e-commerce, finance managers, insurance companies.

Support

Phone Support
24/7 Live Support
Online

Support

Phone Support
24/7 Live Support
Online

API

Offers API

API

Offers API

Screenshots and Videos

Screenshots and Videos

Pricing

No information available.
Free Version
Free Trial

Pricing

one time licensing fee
Discount for multiple licenses.
License fee includes one year maintenance program (MP); MP includes technical support trough email and software upgrades.
Option to continue MP after the first year.
Free Version
Free Trial

Reviews/Ratings

Overall 0.0 / 5
ease 0.0 / 5
features 0.0 / 5
design 0.0 / 5
support 0.0 / 5

This software hasn't been reviewed yet. Be the first to provide a review:

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Reviews/Ratings

Overall 0.0 / 5
ease 0.0 / 5
features 0.0 / 5
design 0.0 / 5
support 0.0 / 5

This software hasn't been reviewed yet. Be the first to provide a review:

Review this Software

Training

Documentation
Webinars
Live Online
In Person

Training

Documentation
Webinars
Live Online
In Person

Company Information

Shift Technology
Founded: 2013
France
www.shift-technology.com/products/payment-integrity

Company Information

WizSoft
Founded: 1983
Israel
www.wizsoft.com/wizrule/

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Categories

Categories

Audit Features

Alerts / Notifications
Audit Planning
Compliance Management
Dashboard
Exceptions Management
Forms Management
Issue Management
Mobile Access
Multi-Year Planning
Risk Assessment
Workflow Management

Fraud Detection Features

Access Security Management
Check Fraud Monitoring
Custom Fraud Parameters
For Banking
For Crypto
For eCommerce
For Insurance Industry
Internal Fraud Monitoring
Investigator Notes
Pattern Recognition
Transaction Approval

Integrations

No info available.

Integrations

No info available.
Claim Shift Payment Integrity and update features and information
Claim Shift Payment Integrity and update features and information
Claim WizRule and update features and information
Claim WizRule and update features and information