Gamma is a platform for identifying and investigating inappropriate healthcare claiming patterns. Where HIBIS focuses on individual claims, Gamma extends this by using a risk scoring approach to evaluate the totality of provider claiming behaviour.
Gamma uses a flexible analytical framework to assess provider claiming trends across a range of behavioural indicators. The platform can be adapted to monitor a range of different behaviours, such as non-provision or misrepresentation of services or the delivery of medically unnecessary procedures. Gamma can be applied to monitor patterns at any level, e.g. provider, practice, or member.
Gamma overlays its advanced analytical approaches with an easy-to-use interface. The simple, prioritised workflow enables users to efficiently:
- Identify and prioritise anomalous claiming behaviour
- Evaluate areas of concern with clear charts and graphs
- Gain more context by drilling down to individual claims
- Distribute cases for investigation and resolution to other team members
Gamma’s combination of advanced analytics, data visualisation techniques and workflow tools ensures operational efforts focus on cases which return the highest value.