Shift Payment IntegrityShift Technology
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Related Products
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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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About
Providing Large Corporations With Early Insights To Reduce Employee Misbehavior And Internal Risks. What is eLoomina? eLoomina is a sophisticated employee behavioral analysis tool to raise employees misbehavioral red flags as early as possible. How It Works. 5% - Cost Of Internal Fraud Out Of Annual Revenue. $130k - Median Loss Per Case. More than $1m Lost In 22% Of Internal Fraud Cases. 16 Months Median Duration Of An Internal Fraud Scheme. Behavioral Red Flags Were Present In 85% Of Cases. Most Incidents Are Not Discovered Or Discovered Too Late. 40% Tip, 15% Internal Audit, 13% Management Review Only 3% Discovered Via Technology.
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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 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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Audience
Large corporations looking for a software platform to know early insights to reduce employee misbehavior and internal risks
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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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Screenshots and Videos |
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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 InformationShift Technology
Founded: 2013
France
www.shift-technology.com/products/payment-integrity
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Company InformationeLoomina
Israel
www.eloomina.com
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Integrations
No info available.
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Integrations
No info available.
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