Shift Payment Integrity

Shift Payment Integrity

Shift Technology
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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

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.

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

Large corporations looking for a software platform to know early insights to reduce employee misbehavior and internal risks

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

No information available.
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

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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

eLoomina
Israel
www.eloomina.com

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Categories

Categories

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 eLoomina and update features and information
Claim eLoomina and update features and information