Holistic, End-to-End Fraud, Waste and Abuse Services for Healthcare PayersCGI’s end-to-end fraud, waste and abuse services incorporate Social Media Protection Services along with traditional pre-pay, post-pay and reimbursement solutions to identify, detect and scrub improper activities on social media sites across a wide array of venues—in real time—to provide ...
CGI ProperPay provides predictive analytics, workflow management, rules management and global best practices. The solution is configurable to an organization’s specific business rules and reimbursement methodologies. CGI also provides expert audit services covering all provider types, focusing on payment issues with a high rate of error and that yield a return on investment.
- Advanced algorithms to predict hidden patterns and anomalies within the entire claims data universe to identify high-potential claims for recovery
- Analytics to prevent fraudulent activity and keep patients safer, allowing staff to easily identify patterns and research claims as well as audit data through a series of views and dashboards
- Security to protect health information: CGI ProperPay meets a broad set of international and industry-specific compliance standards
- Technology to identify, stop and recover improper payments to preserve healthcare funds and revenue
- Holistic, end-to-end fraud, waste and abuse prevention services
- Recovery audit services
- Healthcare claims analytics
- Healthcare payer solutions
- Financial strategies and consulting service
- Social media monitoring
- Appeals services
Specialized healthcare professionals with 25+ years of experience in analyzing and auditing medical claims data
Recovery of $3+ billion in improper medical claims for government and commercial payers
Performance of reviews and audits on behalf of commercial payers throughout the U.S.
Breadth and depth of knowledge of a variety of payment methodologies, state and federal regulations and medical policies and contracts unique to each payer
Proven claims audit and recovery services that have been used to audit approximately 30 million covered lives by payers ranging in size from 60,000 to 9 million members