Our first-of-its-kind platform intakes and harmonizes claims, and analyzes 600+ variables on providers, members, claims, facilities, and pharmacies to generate highly precise fraud scores. Using adaptive predictive analytics, we identify questionable claims, including procedures done too quickly or too often, and underutilized or mismatched procedures. Our behavior profiling technology allows us to identify patterns of provider and patient behavior to flag deviations and significant events.
This happens in real time, before the claim is paid. Legitimate payments and reimbursements are not delayed, and workflow is uninterrupted.
Claims are captured from all sources, including medical, pharmacy, facility claims, and dental administrators.
By harmonizing all claims in a single database, 4C is able to analyze across providers and patients to identify and defend waste and fraud that traditional programs cannot.
Based on historical claims data and requirements of each employer, 4C establishes unique thresholds to identify highly-questionable claims. Cleared claims are processed instantly so payments and reimbursements are not delayed.