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. It can be applied to monitor patters at any level– e.g. provider, practice, or member.
Gamma overlays its advanced analytical approaches with an easy to use interface. Its simple, prioritised workflow to 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.